Individual provider Active NPI

Joel Lopez

  • Family Nurse Practitioner
  • Chino, CA
National Provider Identifier
1104391200
Registry record updated Mar 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
95023964 Issued in CA
Practice address
5562 Philadelphia St Ste 301
Chino, CA 91710-2499
Phone
(214) 868-4371
NPI assigned
Oct 4, 2018
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 30, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered NurseGroup: 193400000X SINGLE SPECIALTY GROUP 163W00000X 95155507 CA
Family Nurse Practitioner 363LF0000X 95023964 CA Primary

Addresses

Primary practice location

5562 Philadelphia St Ste 301
Chino, CA 91710-2499

Mailing address

3454 Del Rey St
San Diego, CA 92109-5752
Phone (619) 995-0303

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231228001336 CA Practitioner - Nurse Practitioner 3779933015 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
95155507CAMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Housecall Doctors Medical Group Inc Single Specialty CurrentSince Dec 4, 2023 Accepting new patients

Locations

3800 Kilroy Airport Way
Ste 270
Long Beach, CA 90806
Phone (949) 366-1053

Interoperability endpoints

  • Direct secure messaging: joel.lopez.1@29786.direct.athenahealth.com

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1538611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680134400000",
    "number": "1104391200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3454 DEL REY ST",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921095752",
            "telephone_number": "619-995-0303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5562 PHILADELPHIA ST STE 301",
            "city": "CHINO",
            "state": "CA",
            "postal_code": "917102499",
            "telephone_number": "214-868-4371"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOPEZ",
        "first_name": "JOEL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-10-04",
        "last_updated": "2023-03-30",
        "certification_date": "2023-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "95155507",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95023964",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chino, CA

Sources for this page

Verify at the official NPI Registry.