Healthcare Provider Details

I. General information

NPI: 1548030919
Provider Name (Legal Business Name): JENNIFER MARIE LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2024
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 MAIN ST
RED BLUFF CA
96080-2759
US

IV. Provider business mailing address

135 MULBERRY AVE
RED BLUFF CA
96080-2404
US

V. Phone/Fax

Practice location:
  • Phone: 530-527-9460
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: