Healthcare Provider Details

I. General information

NPI: 1124667779
Provider Name (Legal Business Name): RITO A LOPEZ NURSE PRACTITIONER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2019
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1666 PRECISION PARK LN
SAN YSIDRO CA
92173-1346
US

IV. Provider business mailing address

1371 E LEXINGTON AVE APT 24
EL CAJON CA
92019-2318
US

V. Phone/Fax

Practice location:
  • Phone: 619-662-4100
  • Fax: 619-600-4870
Mailing address:
  • Phone: 619-490-0914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95013287
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: