Healthcare Provider Details

I. General information

NPI: 1306575469
Provider Name (Legal Business Name): FERNANDA DEL RIO-LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2022
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6370 MAGNOLIA AVE STE 340
RIVERSIDE CA
92506-2404
US

IV. Provider business mailing address

4221 WILSHIRE BLVD STE 300A
LOS ANGELES CA
90010-3537
US

V. Phone/Fax

Practice location:
  • Phone: 888-428-3223
  • Fax: 323-866-1881
Mailing address:
  • Phone: 888-428-3223
  • Fax: 323-866-1881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: