Provider Demographics
NPI:1124667779
Name:LOPEZ, RITO A (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:RITO
Middle Name:A
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1371 E LEXINGTON AVE APT 24
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92019-2318
Mailing Address - Country:US
Mailing Address - Phone:619-490-0914
Mailing Address - Fax:
Practice Address - Street 1:340 4TH AVE STE 10
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-3813
Practice Address - Country:US
Practice Address - Phone:619-934-2215
Practice Address - Fax:619-500-5955
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-30
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95013287363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily