Healthcare Provider Details

I. General information

NPI: 1972266286
Provider Name (Legal Business Name): DAVID XAVIER LOPEZ FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2021
Last Update Date: 10/05/2022
Certification Date: 10/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1971 E 4TH ST STE 200
SANTA ANA CA
92705-3917
US

IV. Provider business mailing address

10781 MUSCARI WAY
LAS VEGAS NV
89141-4246
US

V. Phone/Fax

Practice location:
  • Phone: 888-959-5192
  • Fax:
Mailing address:
  • Phone: 208-351-2786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number843192
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: