MEDICARE: EVELYN CAROLINA LOPEZ PEREZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1043037385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVELYN CAROLINA LOPEZ PEREZ

Provider Business Mailing Address
First Line	:	2600 CORDE TERRA CIR APT 6317
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95111-1950
Country	:	US
Telephone Number	:	669-287-4113
Fax Number	:

Provider Business Practice Location Address
First Line	:	2600 CORDE TERRA CIR APT 6317
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95111-1950
Country	:	US
Telephone Number	:	669-287-4113
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2024
Last Update Date	:	09/26/2024

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Directions to “ EVELYN CAROLINA LOPEZ PEREZ ” Practice Location

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