Provider Demographics
NPI:1902654536
Name:JORGE R LOPEZ MD A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:JORGE R LOPEZ MD A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JROGE
Authorized Official - Middle Name:RUIZ
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-825-1844
Mailing Address - Street 1:2740 S BRISTOL ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-6232
Mailing Address - Country:US
Mailing Address - Phone:714-825-1844
Mailing Address - Fax:
Practice Address - Street 1:2740 S BRISTOL ST STE 100
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-6232
Practice Address - Country:US
Practice Address - Phone:714-825-1844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care