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General NPI Number Information
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NPI Number | 1104576909
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Entity Type | Individual
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Provider Name | ANDREA NICOLE LOPEZ D.O.
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Gender | Female
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Dates
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Enumeration Date | 03/24/2022
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Last Update Date | 05/05/2025
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Provider Practice Location Address
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Address Line | 11234 ANDERSON ST BLDG SUITEC
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City | LOMA LINDA
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State | CA
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Zip | 92350-1716
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Country | US
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Telephone | 909-558-9532
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Fax |
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Provider Business Mailing Address
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Address Line | 10935 TERRA VISTA PKWY APT 103
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-6350
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Country | US
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Telephone | 909-377-9291
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 20A22120
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | CA
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