Healthcare Provider Details

I. General information

NPI: 1821358979
Provider Name (Legal Business Name): JULIE RENE LOPES RN, NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2012
Last Update Date: 12/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13522 NEWPORT AVE STE 102
TUSTIN CA
92780-3707
US

IV. Provider business mailing address

13522 NEWPORT AVE STE 102
TUSTIN CA
92780-3707
US

V. Phone/Fax

Practice location:
  • Phone: 714-573-8200
  • Fax:
Mailing address:
  • Phone: 714-573-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number21852
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: