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General NPI Number Information
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NPI Number | 1144040809
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Entity Type | Individual
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Provider Name | ALONDRA REYNA LOPEZ
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Gender | Female
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Dates
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Enumeration Date | 10/16/2024
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Last Update Date | 10/16/2024
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Provider Practice Location Address
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Address Line | 10375 FORD AVE STE A-3
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City | RICHMOND HILL
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State | GA
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Zip | 31324-9036
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Country | US
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Telephone | 912-500-5800
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Fax |
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Provider Business Mailing Address
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Address Line | 819 ROBIN HOOD TRL APT 38
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City | STATESBORO
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State | GA
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Zip | 30458-6082
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Country | US
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Telephone |
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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 | 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 |
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