Individual
RAYMON LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RADT
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
R126580917
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1255783635
MEDI-CAL
CA
Enumeration date
05/28/2019
Last updated
05/28/2019
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