Healthcare Provider Details

I. General information

NPI: 1780903179
Provider Name (Legal Business Name): SANDRA LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2010
Last Update Date: 06/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 CONSTITUTION BLVD BLDG 151, SUITE 16
SALINAS CA
93906-3100
US

IV. Provider business mailing address

9015 MURRAY AVENUE SUITE 100
GILROY CA
95020
US

V. Phone/Fax

Practice location:
  • Phone: 831-769-8660
  • Fax:
Mailing address:
  • Phone: 408-842-7138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: