Healthcare Provider Details

I. General information

NPI: 1194464321
Provider Name (Legal Business Name): VANESSA ENRIQUEZ LOPEZ NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2022
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 ALTON PKWY STE 101
IRVINE CA
92606-5032
US

IV. Provider business mailing address

16978 RORIMER ST
LA PUENTE CA
91744-4941
US

V. Phone/Fax

Practice location:
  • Phone: 949-222-2722
  • Fax:
Mailing address:
  • Phone: 626-474-6142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95025645
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: