Provider Demographics
NPI:1447473244
Name:FRANK JAVIER LOPEZ
Entity type:Organization
Organization Name:FRANK JAVIER LOPEZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:J
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-352-9203
Mailing Address - Street 1:11731 STERLING AVE
Mailing Address - Street 2:SUITE H
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-4958
Mailing Address - Country:US
Mailing Address - Phone:951-352-9203
Mailing Address - Fax:951-352-9205
Practice Address - Street 1:11731 STERLING AVE
Practice Address - Street 2:SUITE H
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-4958
Practice Address - Country:US
Practice Address - Phone:951-352-9203
Practice Address - Fax:951-352-9205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5272930001Medicare NSC
CA5272930001Medicare ID - Type UnspecifiedPROVIDER NUMBER