Healthcare Provider Details

I. General information

NPI: 1629893557
Provider Name (Legal Business Name): MARINA LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2024
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3050 N ORMSBY BLVD
CARSON CITY NV
89703-8378
US

IV. Provider business mailing address

3050 N ORMSBY BLVD
CARSON CITY NV
89703-8378
US

V. Phone/Fax

Practice location:
  • Phone: 775-753-7626
  • Fax: 775-841-4660
Mailing address:
  • Phone:
  • Fax: 775-841-4660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number810285
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: