Provider Demographics
NPI:1689481384
Name:LOPEZ, LISA MARIE (REGISTERED NURSE)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MARIE
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 S ROSE AVE
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93033-6683
Mailing Address - Country:US
Mailing Address - Phone:805-678-5832
Mailing Address - Fax:805-678-5932
Practice Address - Street 1:4000 S ROSE AVE
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93033-6683
Practice Address - Country:US
Practice Address - Phone:805-678-5832
Practice Address - Fax:805-678-5832
Is Sole Proprietor?:No
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA673280163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice