Healthcare Provider Details

I. General information

NPI: 1538738661
Provider Name (Legal Business Name): MARY ALYSSA LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2021
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 W CYPRESS AVE
VISALIA CA
93277-8300
US

IV. Provider business mailing address

399318
SAN FRANCISCO CA
94139-9318
US

V. Phone/Fax

Practice location:
  • Phone: 559-730-7300
  • Fax:
Mailing address:
  • Phone: 866-523-4268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberA5117BCE7F
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: