Healthcare Provider Details

I. General information

NPI: 1003201542
Provider Name (Legal Business Name): BELESHIA NYGEA LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2015
Last Update Date: 04/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3910 3RD AVE
LOS ANGELES CA
90008-2706
US

IV. Provider business mailing address

PO BOX 561571
LOS ANGELES CA
90056-0238
US

V. Phone/Fax

Practice location:
  • Phone: 213-479-2943
  • Fax: 323-792-4464
Mailing address:
  • Phone: 213-479-2943
  • Fax: 323-792-4464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: