Basic Information
| Provider Information | |||||||||
| NPI: | 1669989125 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LOPEZ | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | VANESSA | ||||||||
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| Credential: | LVN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 36 S KINNELOA AVE STE 100 | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911073853 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6268443033 | ||||||||
| FaxNumber: | 6268443034 | ||||||||
| Practice Location | |||||||||
| Address1: | 1910 N BUSH ST | ||||||||
| Address2: | |||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927062816 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7143617950 | ||||||||
| FaxNumber: | 7143617966 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/05/2018 | ||||||||
| LastUpdateDate: | 11/17/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164X00000X | 693345 | CA | Y | Nursing Service Providers | Licensed Vocational Nurse |
No ID Information.