MEDICARE: ANGELICA LOPEZ MACEN FNP-BC

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	363LF0000X	Family Nurse Practitioner	95037866	CA

General Provider Information

NPI Number	:	1053275586
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELICA LOPEZ MACEN FNP-BC

Provider Business Mailing Address
First Line	:	885 PATRIOT DR STE F
Second Line	:
City	:	MOORPARK
State	:	CA
Zip	:	93021-3353
Country	:	US
Telephone Number	:	805-334-1371
Fax Number	:

Provider Business Practice Location Address
First Line	:	885 PATRIOT DR STE F
Second Line	:
City	:	MOORPARK
State	:	CA
Zip	:	93021-3353
Country	:	US
Telephone Number	:	805-334-1371
Fax Number	:

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

Provider Enumeration Date	:	12/10/2025
Last Update Date	:	12/10/2025

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