Healthcare Provider Details

I. General information

NPI: 1306703673
Provider Name (Legal Business Name): TIFFANY LYNN LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2026
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 HOAG ST
CORNING CA
96021-2955
US

IV. Provider business mailing address

1005 HOAG ST
CORNING CA
96021-2955
US

V. Phone/Fax

Practice location:
  • Phone: 530-824-7700
  • Fax: 530-824-2493
Mailing address:
  • Phone: 530-824-7700
  • Fax: 530-824-2493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License NumberA008230A23
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: