Healthcare Provider Details

I. General information

NPI: 1720780034
Provider Name (Legal Business Name): JOCELYN GONZALEZ LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 QUALITY DR
VACAVILLE CA
95688-9494
US

IV. Provider business mailing address

1 QUALITY DR
VACAVILLE CA
95688-9494
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-2737
  • Fax:
Mailing address:
  • Phone: 916-734-2737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA197738
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: