Provider Demographics
NPI:1588558670
Name:LOPEZ JUAREZ, MARISSA S
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:S
Last Name:LOPEZ JUAREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1260 MORENA BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-3889
Mailing Address - Country:US
Mailing Address - Phone:619-398-3261
Mailing Address - Fax:
Practice Address - Street 1:1260 MORENA BLVD STE 2
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-3889
Practice Address - Country:US
Practice Address - Phone:619-398-3261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-04
Last Update Date:2025-07-31
Deactivation Date:2025-06-12
Deactivation Code:
Reactivation Date:2025-07-31
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner