Provider Demographics
NPI:1538240908
Name:LOPEZ, IRMA (MD)
Entity type:Individual
Prefix:DR
First Name:IRMA
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 N EUCLID AVE
Mailing Address - Street 2:STE: A
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-3224
Mailing Address - Country:US
Mailing Address - Phone:909-391-3423
Mailing Address - Fax:909-391-3424
Practice Address - Street 1:602 N EUCLID AVE
Practice Address - Street 2:STE: A
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-3224
Practice Address - Country:US
Practice Address - Phone:909-391-3423
Practice Address - Fax:909-391-3424
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG57022208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G57022Medicaid
CAE56204Medicare UPIN