Provider Demographics
NPI:1992818934
Name:CARLOS A. LOPEZ A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:CARLOS A. LOPEZ A PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:ALBERTO
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-773-9750
Mailing Address - Street 1:39700 BOB HOPE DR STE 110
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-7103
Mailing Address - Country:US
Mailing Address - Phone:760-773-9750
Mailing Address - Fax:760-773-9294
Practice Address - Street 1:39700 BOB HOPE DR STE 110
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-7103
Practice Address - Country:US
Practice Address - Phone:760-773-9750
Practice Address - Fax:760-773-9294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ01598ZMedicare ID - Type Unspecified