Provider Demographics
NPI:1295002277
Name:LOPEZ, ELIDIA (MEDICAL ASSISTANT)
Entity Type:Individual
Prefix:
First Name:ELIDIA
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MEDICAL ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 FELICE DR
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-3361
Mailing Address - Country:US
Mailing Address - Phone:831-637-5306
Mailing Address - Fax:831-637-5842
Practice Address - Street 1:351 FELICE DRIVE
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023
Practice Address - Country:US
Practice Address - Phone:831-637-5306
Practice Address - Fax:831-637-5842
Is Sole Proprietor?:No
Enumeration Date:2011-11-19
Last Update Date:2011-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator