Provider Demographics
NPI:1194464321
Name:LOPEZ, VANESSA ENRIQUEZ (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:ENRIQUEZ
Last Name:LOPEZ
Suffix:
Gender:F
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 1:16978 RORIMER ST
Mailing Address - Street 2:
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91744-4941
Mailing Address - Country:US
Mailing Address - Phone:626-474-6142
Mailing Address - Fax:
Practice Address - Street 1:2500 ALTON PKWY STE 101
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92606-5032
Practice Address - Country:US
Practice Address - Phone:949-222-2722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-04
Last Update Date:2025-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95025645363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty