Provider Demographics
NPI:1205940723
Name:LOPEZ, JAIME (MD)
Entity type:Individual
Prefix:DR
First Name:JAIME
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5485
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90607-5485
Mailing Address - Country:US
Mailing Address - Phone:562-693-0735
Mailing Address - Fax:562-698-3573
Practice Address - Street 1:8135 PAINTER AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-3158
Practice Address - Country:US
Practice Address - Phone:562-693-0735
Practice Address - Fax:562-698-3573
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG50641207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G506410Medicaid
CAG50641Medicare ID - Type Unspecified
CAA92995Medicare UPIN