Basic Information
| Provider Information | |||||||||
| NPI: | 1932312600 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LOPEZ | ||||||||
| FirstName: | LILLIAN | ||||||||
| MiddleName: | YVETTE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9500 MENTOR AVENUE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | MENTOR | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440600069 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4403524880 | ||||||||
| FaxNumber: | 4403523629 | ||||||||
| Practice Location | |||||||||
| Address1: | 33758 YUCAIPA BLVD | ||||||||
| Address2: | |||||||||
| City: | YUCAIPA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923992243 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9097959747 | ||||||||
| FaxNumber: | 9097973922 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2007 | ||||||||
| LastUpdateDate: | 03/01/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 20A10228 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | CA195175 | 01 | CA | MEDICARE | OTHER |