MEDICARE: LYNDA LOPEZ-FREYRE FNP-C PROFESSIONAL NURSING CORPORATION

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	363L00000X	Nurse Practitioner

General Provider Information

NPI Number	:	1720849276
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LYNDA LOPEZ-FREYRE FNP-C PROFESSIONAL NURSING CORPORATION

Provider Business Mailing Address
First Line	:	424 BERYL COVE WAY
Second Line	:
City	:	SEAL BEACH
State	:	CA
Zip	:	90740-6218
Country	:	US
Telephone Number	:	562-852-3758
Fax Number	:

Provider Business Practice Location Address
First Line	:	424 BERYL COVE WAY
Second Line	:
City	:	SEAL BEACH
State	:	CA
Zip	:	90740-6218
Country	:	US
Telephone Number	:	562-852-3758
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	LYNDA LOPEZ-FREYRE
Credential	:
Telephone Number	:	562-852-3758

Provider Enumeration Date	:	01/22/2024
Last Update Date	:	01/22/2024

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