Provider Demographics
NPI:1356322911
Name:LOPEZ, CRISTINA (PA)
Entity Type:Individual
Prefix:MS
First Name:CRISTINA
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2134 10TH ST
Mailing Address - Street 2:
Mailing Address - City:SANGER
Mailing Address - State:CA
Mailing Address - Zip Code:93657-2959
Mailing Address - Country:US
Mailing Address - Phone:559-875-4060
Mailing Address - Fax:559-876-9461
Practice Address - Street 1:2570 JENSEN AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:SANGER
Practice Address - State:CA
Practice Address - Zip Code:93657-2269
Practice Address - Country:US
Practice Address - Phone:559-876-1402
Practice Address - Fax:559-876-9461
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13025363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA13025OtherPHYSICIAN ASSISTANT
CA1024301OtherNCCPA
CAML0950926OtherDEA NUMBER