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General NPI Number Information
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NPI Number | 1629421102
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Entity Type | Individual
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Provider Name | ADITAIM LOPEZ MARTINEZ N.P.
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Gender | Female
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Dates
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Enumeration Date | 07/19/2016
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Last Update Date | 07/19/2016
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Provider Practice Location Address
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Address Line | 13522 NEWPORT AVE UNIT 200
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City | TUSTIN
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State | CA
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Zip | 92780-3707
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Country | US
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Telephone | 800-658-5877
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Fax |
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Provider Business Mailing Address
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Address Line | 1354 KILBY LN
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City | VISTA
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State | CA
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Zip | 92083-7166
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Country | US
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Telephone | 760-845-0363
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 95004455
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License Number State | CA
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