Individual
LIDUVINA LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9527 MADISON AVE, SOUTH GATE, CA 90280-4229
(323) 601-3321
Mailing address
9527 MADISON AVE, SOUTH GATE, CA 90280-4229
(323) 601-3321
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
91192
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
91192
—
CA
Enumeration date
04/20/2021
Last updated
04/20/2021
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