Healthcare Provider Details

I. General information

NPI: 1184192411
Provider Name (Legal Business Name): ADRIANA VANESSA NUNEZ LOPEZ NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2018
Last Update Date: 11/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1031 WATERLOO RD
STOCKTON CA
95205-4256
US

IV. Provider business mailing address

7210 MURRAY DR
STOCKTON CA
95210-3339
US

V. Phone/Fax

Practice location:
  • Phone: 209-940-5600
  • Fax: 209-762-6808
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number95009714
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: