MEDICARE: PAULINA LOPEZ F.N.P.

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	95001338	CA

General Provider Information

NPI Number	:	1255737144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAULINA LOPEZ F.N.P.

Provider Business Mailing Address
First Line	:	9925 INTERNATIONAL BLVD
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94603-2558
Country	:	US
Telephone Number	:	510-777-1177
Fax Number	:

Provider Business Practice Location Address
First Line	:	475 38TH ST
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94609-2731
Country	:	US
Telephone Number	:	510-542-3669
Fax Number	:

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

Provider Enumeration Date	:	11/05/2014
Last Update Date	:	11/05/2014

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