MEDICARE: MISS ELIZABETH ANN LOPEZ CRNA

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	390200000X	Student in an Organized Health Care Education/Training Program	603998	CA
2	367500000X	Certified Registered Nurse Anesthetist	3828	CA

General Provider Information

NPI Number	:	1457592917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ELIZABETH ANN LOPEZ CRNA

Provider Business Mailing Address
First Line	:	1811 S NEW ENGLAND ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-5313
Country	:	US
Telephone Number	:	323-270-1244
Fax Number	:

Provider Business Practice Location Address
First Line	:	1811 S NEW ENGLAND ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-5313
Country	:	US
Telephone Number	:	323-270-1244
Fax Number	:

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

Provider Enumeration Date	:	03/13/2009
Last Update Date	:	07/01/2016

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