Healthcare Provider Details

I. General information

NPI: 1306757950
Provider Name (Legal Business Name): JUAN ANTONIO LOPEZ LVN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6700 EUCALYPTUS DR STE A
BAKERSFIELD CA
93306-6076
US

IV. Provider business mailing address

7501 OLYMPIA DR APT C
BAKERSFIELD CA
93309-7562
US

V. Phone/Fax

Practice location:
  • Phone: 661-363-8127
  • Fax:
Mailing address:
  • Phone: 661-557-0767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number728731
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: