Healthcare Provider Details

I. General information

NPI: 1548345143
Provider Name (Legal Business Name): MARVIN JAMES LOPEZ BARRUGA CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 S ATLANTIC BLVD STE 201
MONTEREY PARK CA
91754-6705
US

IV. Provider business mailing address

PO BOX 4259
CERRITOS CA
90703-4259
US

V. Phone/Fax

Practice location:
  • Phone: 909-570-9108
  • Fax: 909-570-9334
Mailing address:
  • Phone: 562-407-2080
  • Fax: 562-407-2082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberNA 2607
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: