Provider Demographics
NPI:1407586381
Name:LOPEZ, DIANA VILLALPANDO (RN)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:VILLALPANDO
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16267 SANTA BIANCA DR
Mailing Address - Street 2:
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-4808
Mailing Address - Country:US
Mailing Address - Phone:562-413-9161
Mailing Address - Fax:
Practice Address - Street 1:11541 ROSECRANS AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-3898
Practice Address - Country:US
Practice Address - Phone:562-923-9414
Practice Address - Fax:562-622-1879
Is Sole Proprietor?:No
Enumeration Date:2022-06-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95035022163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse