Individual
JASON LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
100 E VALENCIA MESA DR STE 310, FULLERTON, CA 92835-3800
(714) 734-3120
Mailing address
100 E VALENCIA MESA DR STE 310, FULLERTON, CA 92835-3800
(714) 734-3120
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
55964
CA
363AM0700X
Medical Physician Assistant
55964
CA
363AS0400X
Surgical Physician Assistant
Primary
55964
CA
Other
Enumeration date
05/17/2018
Last updated
07/13/2021
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