Individual provider Active NPI

Lisa Marie Lopez, M.D.

  • Family Medicine Physician
  • Long Beach, CA
National Provider Identifier
1417264383
Registry record updated Dec 4, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A119295 Issued in CA
Practice address
1333 Chestnut Ave
Long Beach, CA 90813-2944
Phone
(562) 753-2301
Fax
(562) 753-2320
NPI assigned
Sep 13, 2010
Last updated
Dec 4, 2019By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 4, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X A119295 CA Primary

Addresses

Primary practice location

1333 Chestnut Ave
Long Beach, CA 90813-2944

Mailing address

1333 Chestnut Ave
Long Beach, CA 90813-2944
Phone (562) 753-2301

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150708001964 CA Practitioner - Family Practice 2567695133 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of California, San Diego School of Medicine, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
County of Los AngelesGroup PAC ID 1850296534, 395 clinicians

Practice addresses (Care Compare)

12021 S Wilmington Ave
Room 1059
Los Angeles, CA 90059-3019

1333 Chestnut Ave
Long Beach, CA 90813-2944
Phone (562) 753-2315

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of nail tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A119295CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
County of Los Angeles CurrentSince May 1, 2015 Accepting new patients
County of Los Angeles CurrentSince May 1, 2015 Accepting new patients
County of Los Angeles Current Accepting new patients
County of Los Angeles - Auditor Controller Past Accepting new patients

Locations

1000 S Fremont Ave
Unit 9
Alhambra, CA 91803

1333 Chestnut Ave
Long Beach, CA 90813
Phone (562) 599-8601

Organizations & group practices 4

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

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1284336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1575417600000",
    "number": "1417264383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1333 CHESTNUT AVE",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908132944",
            "telephone_number": "562-753-2301",
            "fax_number": "562-753-2320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1333 CHESTNUT AVE",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908132944",
            "telephone_number": "562-753-2301",
            "fax_number": "562-753-2320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOPEZ",
        "first_name": "LISA",
        "middle_name": "MARIE",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-09-13",
        "last_updated": "2019-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A119295",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Long Beach, CA

Sources for this page

Verify at the official NPI Registry.