Healthcare Provider Details

I. General information

NPI: 1699923433
Provider Name (Legal Business Name): LISA MICHELE LOPEZ FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2008
Last Update Date: 01/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1374 E ALLUVIAL AVE
FRESNO CA
93720-2608
US

IV. Provider business mailing address

533 AUTUMN RD
MADERA CA
93637-4136
US

V. Phone/Fax

Practice location:
  • Phone: 559-981-2600
  • Fax: 559-981-2610
Mailing address:
  • Phone: 559-474-5533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number16590
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: