MEDICARE: PERLA CORRAL 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	163W00000X	Registered Nurse	95101496	CA

General Provider Information

NPI Number	:	1568318616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PERLA CORRAL LOPEZ

Provider Business Mailing Address
First Line	:	879 POOL ST
Second Line	:
City	:	LAKEPORT
State	:	CA
Zip	:	95453-4241
Country	:	US
Telephone Number	:	707-472-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	511 S ORCHARD AVE
Second Line	:
City	:	UKIAH
State	:	CA
Zip	:	95482-3470
Country	:	US
Telephone Number	:	707-472-5000
Fax Number	:

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

Provider Enumeration Date	:	03/09/2026
Last Update Date	:	03/09/2026

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Directions to “ PERLA CORRAL LOPEZ ” Practice Location

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