Provider Demographics
NPI:1609221092
Name:LOPEZ, LUIS DANIEL (LAC)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:DANIEL
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16488 WILT RD
Mailing Address - Street 2:
Mailing Address - City:SISTERS
Mailing Address - State:OR
Mailing Address - Zip Code:97759-9688
Mailing Address - Country:US
Mailing Address - Phone:858-243-5990
Mailing Address - Fax:
Practice Address - Street 1:16488 WILT RD
Practice Address - Street 2:
Practice Address - City:SISTERS
Practice Address - State:OR
Practice Address - Zip Code:97759-9688
Practice Address - Country:US
Practice Address - Phone:858-243-5990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-04
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC177747171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist