Individual
RAYMON LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RADT
Contact information
Practice address
1919 N BEACHWOOD DR, LOS ANGELES, CA 90068-4006
(323) 463-4266
(323) 962-6721
Mailing address
1919 N BEACHWOOD DR, LOS ANGELES, CA 90068-4006
(323) 463-4266
(323) 962-6721
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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