Provider Demographics
NPI:1396764387
Name:LOPEZ, OFELIA (NP)
Entity type:Individual
Prefix:
First Name:OFELIA
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:383 BAY SHORE AVE
Mailing Address - Street 2:UNIT 419
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-1955
Mailing Address - Country:US
Mailing Address - Phone:951-377-1041
Mailing Address - Fax:
Practice Address - Street 1:383 BAY SHORE AVE
Practice Address - Street 2:UNIT 419
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-1955
Practice Address - Country:US
Practice Address - Phone:951-377-1041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP950363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1396764387Medicaid
CANP0009500Medicaid
CA1154474989Medicaid