Healthcare Provider Details

I. General information

NPI: 1235456526
Provider Name (Legal Business Name): TESLA YAMILETH LOPEZ-ORTEGA NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2010
Last Update Date: 10/25/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 HOSPITAL PKWY
SAN JOSE CA
95119-1106
US

IV. Provider business mailing address

1235 MICHAEL BO LN
GILROY CA
95020-2717
US

V. Phone/Fax

Practice location:
  • Phone: 408-506-9775
  • Fax:
Mailing address:
  • Phone: 408-506-9775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95030414
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number758597
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: