Provider Demographics
NPI:1285779959
Name:RICHARD R. LOPEZ, JR.,M.D., INC.
Entity type:Organization
Organization Name:RICHARD R. LOPEZ, JR.,M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:R
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:310-837-2448
Mailing Address - Street 1:10140 BRIDLEVALE DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-4656
Mailing Address - Country:US
Mailing Address - Phone:310-837-2448
Mailing Address - Fax:310-837-2448
Practice Address - Street 1:1245 WILSHIRE BLVD
Practice Address - Street 2:SUITE 611
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-4810
Practice Address - Country:US
Practice Address - Phone:213-481-2158
Practice Address - Fax:213-481-7023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG77986208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty