MEDICARE: MS. CRISTINA LOPEZ PA

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	363A00000X	Physician Assistant	13025	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	13025	OTHER	CA	PHYSICIAN ASSISTANT
2	1024301	OTHER	CA	NCCPA

General Provider Information

NPI Number	:	1356322911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CRISTINA LOPEZ PA

Provider Business Mailing Address
First Line	:	2134 10TH ST
Second Line	:
City	:	SANGER
State	:	CA
Zip	:	93657-2959
Country	:	US
Telephone Number	:	559-875-4060
Fax Number	:	559-876-9461

Provider Business Practice Location Address
First Line	:	2570 JENSEN AVE
Second Line	:	SUITE 102
City	:	SANGER
State	:	CA
Zip	:	93657-2269
Country	:	US
Telephone Number	:	559-876-1402
Fax Number	:	559-876-9461

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

Provider Enumeration Date	:	11/10/2005
Last Update Date	:	03/07/2023

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