MEDICARE: ALEIDA JASMINE LOPEZ

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	225400000X	Rehabilitation Practitioner		CA

General Provider Information

NPI Number	:	1336967629
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEIDA JASMINE LOPEZ

Provider Business Mailing Address
First Line	:	5500 CAMPANILE DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92182-0001
Country	:	US
Telephone Number	:	619-594-6865
Fax Number	:

Provider Business Practice Location Address
First Line	:	6244 EL CAJON BLVD STE 14
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-3918
Country	:	US
Telephone Number	:	619-640-3266
Fax Number	:

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

Provider Enumeration Date	:	09/26/2024
Last Update Date	:	06/08/2026

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Directions to “ ALEIDA JASMINE LOPEZ ” Practice Location

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