Provider Demographics
NPI:1285450031
Name:LOPEZ, JUAN EUGENE JR
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:EUGENE
Last Name:LOPEZ
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1971 E 4TH ST STE 130A
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3944
Mailing Address - Country:US
Mailing Address - Phone:714-547-7559
Mailing Address - Fax:714-244-2135
Practice Address - Street 1:1971 E 4TH ST STE 130A
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3944
Practice Address - Country:US
Practice Address - Phone:714-547-7559
Practice Address - Fax:714-244-2135
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-26
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker