Healthcare Provider Details

I. General information

NPI: 1538869862
Provider Name (Legal Business Name): SYDNEY C LOPEZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2023
Last Update Date: 06/07/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69175 RAMON RD BLDG A
CATHEDRAL CITY CA
92234-3344
US

IV. Provider business mailing address

69175 RAMON RD
CATHEDRAL CITY CA
92234-3344
US

V. Phone/Fax

Practice location:
  • Phone: 760-321-6776
  • Fax:
Mailing address:
  • Phone: 760-321-6776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number62436
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: