Healthcare Provider Details

I. General information

NPI: 1356322911
Provider Name (Legal Business Name): CRISTINA LOPEZ PA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2570 JENSEN AVE SUITE 102
SANGER CA
93657-2269
US

IV. Provider business mailing address

2134 10TH ST
SANGER CA
93657-2959
US

V. Phone/Fax

Practice location:
  • Phone: 559-876-1402
  • Fax: 559-876-9461
Mailing address:
  • Phone: 559-875-4060
  • Fax: 559-876-9461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number13025
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: