Healthcare Provider Details

I. General information

NPI: 1619043312
Provider Name (Legal Business Name): CARMEN VICTORIA LOPEZ CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 N ROXBURY DR THIRD FLOOR
BEVERLY HILLS CA
90210-4232
US

IV. Provider business mailing address

10501 WILSHIRE BLVD #2002
LOS ANGELES CA
90024
US

V. Phone/Fax

Practice location:
  • Phone: 310-453-8911
  • Fax: 310-453-2519
Mailing address:
  • Phone: 310-738-0306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2410
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: