Healthcare Provider Details

I. General information

NPI: 1457158230
Provider Name (Legal Business Name): NATALIE LUISA LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2025
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4985 COMANCHE DR APT 4
LA MESA CA
91942-8117
US

IV. Provider business mailing address

4985 COMANCHE DR APT 4
LA MESA CA
91942-8117
US

V. Phone/Fax

Practice location:
  • Phone: 818-632-2538
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2000060295
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: