Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Dr. Blake Lopez, MD

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1962908111

Dr. Blake Lopez, MD is an Emergency Medicine in LA Mesa, California. Graduated from Michigan State University College of Human Medicine in 2018, 8 years ago. Practices with Shadow Emergency Physicians PLLC, a 109-clinician group, works from 3 locations and accepts Medicare assignment. Licensed in California.

Years since qualifying
8
Trained at
Michigan State University College of Human Medicine
Licensed in
CA
In the registry since
2018
Specialties on file
2
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

See every abbreviation used in this directory →

Practice location Address checks out

5555 Grossmont Center Dr
LA Mesa, CA 91942-3019
Phone: (619) 465-0711
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (2)

  • 630 W 168th St, New York, NY 10032-3725 — (212) 305-2862
  • 525 E 68th St, New York, NY 10065-4870 — (212) 746-5454

Specialties & licences

Emergency Medicine Physician (primary) Taxonomy 207P00000X · Licence A177065 (CA)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1962908111
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedApril 4, 2018
Last updated in NPPESApril 4, 2022
Certification dateMarch 10, 2022
Mailing address50 W 90th St Apt 6b, New York, NY 10024-1564

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyEMERGENCY MEDICINE
Medical schoolMICHIGAN STATE UNIVERSITY COLLEGE OF HUMAN MEDICINE
Graduated 2018 (8 years in practice)
Group practice Shadow Emergency Physicians Pllc — 109 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in LA Mesa