MEDICARE: PALOMA NINA LOPERENA

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	363AS0400X	Surgical Physician Assistant
2	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1407684947
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PALOMA NINA LOPERENA

Provider Business Mailing Address
First Line	:	2888 LONG BEACH BLVD STE 165
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90806-1561
Country	:	US
Telephone Number	:	657-241-9052
Fax Number	:	714-665-4663

Provider Business Practice Location Address
First Line	:	2888 LONG BEACH BLVD STE 165
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90806-1561
Country	:	US
Telephone Number	:	657-241-9052
Fax Number	:	714-665-4663

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

Provider Enumeration Date	:	07/25/2024
Last Update Date	:	11/19/2025

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