Provider Demographics
NPI:1730395096
Name:LOPEZ, SERGIO
Entity type:Individual
Prefix:
First Name:SERGIO
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16700 YUKON AVE APT 205
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-1353
Mailing Address - Country:US
Mailing Address - Phone:310-783-4677
Mailing Address - Fax:
Practice Address - Street 1:16700 YUKON AVE
Practice Address - Street 2:APT 205
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90504-1300
Practice Address - Country:US
Practice Address - Phone:310-783-4677
Practice Address - Fax:310-783-4676
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator