Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | DC27475 | CA |
NPI | 1285704064 |
---|---|
Provider Name | Dr. Juan Jose Lopez |
First Address | San Leandro, CA 94577-3804 |
Second Address | San Leandro, CA 94577-4643 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U84859 | (02) | CA |