Individual
DR. BLAKE LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5555 GROSSMONT CENTER DR, LA MESA, CA 91942-3019
(619) 465-0711
Mailing address
50 W 90TH ST APT 6B, NEW YORK, NY 10024-1564
(619) 243-4901
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
A177065
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/04/2018
Last updated
04/04/2022
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