Healthcare Provider Details

I. General information

NPI: 1164946521
Provider Name (Legal Business Name): AURORA M LOPEZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 FERGUSON DR STE 210-04
COMMERCE CA
90022-5164
US

IV. Provider business mailing address

5555 FERGUSON DR STE 210-04
COMMERCE CA
90022-5164
US

V. Phone/Fax

Practice location:
  • Phone: 323-869-7197
  • Fax: 323-869-8230
Mailing address:
  • Phone: 323-869-7197
  • Fax: 323-869-8230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number402355
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: