Basic Information
| Provider Information | |||||||||
| NPI: | 1841530821 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LOPEZ | ||||||||
| FirstName: | CRISTIAN | ||||||||
| MiddleName: | IVAN | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1417 W LINCOLN AVE | ||||||||
| Address2: | |||||||||
| City: | MONTEBELLO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906403245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232517241 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3820 MARTIN LUTHER KING JR BLVD | ||||||||
| Address2: | |||||||||
| City: | LYNWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902623625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3106320415 | ||||||||
| FaxNumber: | 3106050393 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2013 | ||||||||
| LastUpdateDate: | 04/23/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 700281 | CA | Y | Nursing Service Providers | Registered Nurse |
No ID Information.