Individual
MARIO ALBERTO LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
8788 JAMACHA RD, SPRING VALLEY, CA 91977-4035
(619) 515-2555
Mailing address
823 GATEWAY CENTER WAY, SAN DIEGO, CA 92102-4541
(619) 515-2300
(619) 906-4564
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA21385
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
W5352
UPIN
CA
Enumeration date
06/03/2009
Last updated
03/17/2018
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