Provider Demographics
NPI:1508919259
Name:LOPEZ, CECILIA AMADOR (FNP)
Entity Type:Individual
Prefix:
First Name:CECILIA
Middle Name:AMADOR
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 W WHITTIER BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-4737
Mailing Address - Country:US
Mailing Address - Phone:323-728-8588
Mailing Address - Fax:323-728-4444
Practice Address - Street 1:901 W WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-4737
Practice Address - Country:US
Practice Address - Phone:323-728-8588
Practice Address - Fax:323-728-4444
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAFNP11421363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11420OtherMEDICAL LICENSE
CANP0114210Medicaid