Healthcare Provider Details

I. General information

NPI: 1790971943
Provider Name (Legal Business Name): MAGDALENA LOPEZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2007
Last Update Date: 05/21/2024
Certification Date: 05/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2019 SATURN ST
MONTEREY PARK CA
91755-7415
US

IV. Provider business mailing address

2019 SATURN ST
MONTEREY PARK CA
91755-7415
US

V. Phone/Fax

Practice location:
  • Phone: 323-724-0019
  • Fax:
Mailing address:
  • Phone: 323-724-0019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number488657
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: