Healthcare Provider Details

I. General information

NPI: 1407684947
Provider Name (Legal Business Name): PALOMA NINA LOPERENA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2024
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2888 LONG BEACH BLVD STE 165
LONG BEACH CA
90806-1561
US

IV. Provider business mailing address

2888 LONG BEACH BLVD STE 165
LONG BEACH CA
90806-1561
US

V. Phone/Fax

Practice location:
  • Phone: 657-241-9052
  • Fax: 714-665-4663
Mailing address:
  • Phone: 657-241-9052
  • Fax: 714-665-4663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: