1235211236 NPI number — ANTOINETTE LOPEZ MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235211236 NPI number — ANTOINETTE LOPEZ MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

LOPEZ

Provider First Name:

ANTOINETTE

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1235211236

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

12/30/2014

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 11247

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

BERKELEY

Provider Business Mailing Address State Name:

CA

Provider Business Mailing Address Postal Code:

94712-2247

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

510-981-4100

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

2031 6TH ST

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

BERKELEY

Provider Business Practice Location Address State Name:

CA

Provider Business Practice Location Address Postal Code:

94710-2006

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

510-981-4100

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

10/19/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207Q00000X , with the licence number:  46784 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 207Q00000X , with the licence number: A54812 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 2274032 . This is a "ARAZ" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 782052 . This is a "FAIRVIEW" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 132531 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 367187900 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
• Identifier: HP48293 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 935S7LO . This is a "BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 01-19261 . This is a "MEDICA-CHOICE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 0586909 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1042594 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 2274032 . This is a "AMERICA'S PPO" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 34600900 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".