Healthcare Provider Details

I. General information

NPI: 1952135634
Provider Name (Legal Business Name): PATRICK EVAN LOPEZ DNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2024
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4510 EXECUTIVE DR STE P7
SAN DIEGO CA
92121-3021
US

IV. Provider business mailing address

FILE 57326
LOS ANGELES CA
90074-7326
US

V. Phone/Fax

Practice location:
  • Phone: 800-926-8273
  • Fax:
Mailing address:
  • Phone: 800-926-8273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number95031658
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: