Basic Information
| Provider Information | |||||||||
| NPI: | 1629691514 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LOPEZ | ||||||||
| FirstName: | ADRIANNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1430 BREWERTON DR APT 280 | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958331970 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9166346082 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8928 VOLUNTEER LN | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958263238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9163685114 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2020 | ||||||||
| LastUpdateDate: | 08/04/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.