Healthcare Provider Details

I. General information

NPI: 1255360848
Provider Name (Legal Business Name): ELBA LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 W GRANGEVILLE BLVD
HANFORD CA
93230-2861
US

IV. Provider business mailing address

515 W GRANGEVILLE BLVD
HANFORD CA
93230-2861
US

V. Phone/Fax

Practice location:
  • Phone: 844-623-0999
  • Fax:
Mailing address:
  • Phone: 844-623-0999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number1217
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number10197
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: