Healthcare Provider Details

I. General information

NPI: 1538381348
Provider Name (Legal Business Name): MRS. CHANEL RAMONA LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 DEL NORTE ROAD SUITE 130
CAMARILLO CA
93010-8366
US

IV. Provider business mailing address

1512 REGULUS DRIVE
POINT MUGU CA
93041
US

V. Phone/Fax

Practice location:
  • Phone: 805-485-6114
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: