=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164946521
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AURORA M LOPEZ RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/27/2017
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5555 FERGUSON DR STE 210-04
-----------------------------------------------------
City | COMMERCE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90022-5164
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-869-7197
-----------------------------------------------------
Fax | 323-869-8230
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5555 FERGUSON DR STE 210-04
-----------------------------------------------------
City | COMMERCE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90022-5164
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-869-7197
-----------------------------------------------------
Fax | 323-869-8230
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WC0400X
-----------------------------------------------------
Taxonomy Name | Case Management Registered Nurse
-----------------------------------------------------
License Number | 402355
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------