Healthcare Provider Details

I. General information

NPI: 1922891837
Provider Name (Legal Business Name): VERONICA LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2025
Last Update Date: 05/23/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 12TH ST
MARINA CA
93933-6003
US

IV. Provider business mailing address

299 12TH ST
MARINA CA
93933-6003
US

V. Phone/Fax

Practice location:
  • Phone: 831-647-7652
  • Fax: 831-796-8683
Mailing address:
  • Phone: 831-647-7652
  • Fax: 831-796-8683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: