Provider Demographics
NPI:1548797970
Name:LOPEZ, MICHELLE S (CPHW)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:S
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:CPHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 W LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-6730
Mailing Address - Country:US
Mailing Address - Phone:714-678-2134
Mailing Address - Fax:714-774-4784
Practice Address - Street 1:1820 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-6730
Practice Address - Country:US
Practice Address - Phone:714-678-2134
Practice Address - Fax:714-774-4784
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-16
Last Update Date:2017-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center