Provider Demographics
NPI:1063816254
Name:LOPEZ, LIDIA PAOLA (APN-C)
Entity Type:Individual
Prefix:
First Name:LIDIA
Middle Name:PAOLA
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:APN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5767 W CENTURY BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5631
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2020 SANTA MONICA BLVD STE 580
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2000
Practice Address - Country:US
Practice Address - Phone:310-829-5471
Practice Address - Fax:310-829-6192
Is Sole Proprietor?:No
Enumeration Date:2014-10-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP126538363L00000X
CANP95014584363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP95014584OtherSTATE LICENSE
TX8427NMOtherBCBS
TX340562301Medicaid
TX340562301Medicaid