Healthcare Provider Details

I. General information

NPI: 1174107320
Provider Name (Legal Business Name): YADIRA IN YAMECH LOPEZ MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2021
Last Update Date: 05/12/2021
Certification Date: 05/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6405 MIRA MESA BLVD
SAN DIEGO CA
92121-4147
US

IV. Provider business mailing address

6405 MIRA MESA BLVD STE 210
SAN DIEGO CA
92121-4146
US

V. Phone/Fax

Practice location:
  • Phone: 855-975-8321
  • Fax:
Mailing address:
  • Phone: 866-701-6565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number115745
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: