Individual
LUIS MARIO LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
515 COLUMBIA AVE # 200, LOS ANGELES, CA 90017-1209
(213) 249-9388
(213) 389-7993
Mailing address
515 COLUMBIA AVE # 200, LOS ANGELES, CA 90017-1209
(213) 249-9388
(213) 389-7993
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
Y2334234
CA
Other
Enumeration date
10/07/2020
Last updated
10/07/2020
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