Provider Demographics
NPI:1609340835
Name:LOPEZ, EFRAIN (FNP)
Entity Type:Individual
Prefix:
First Name:EFRAIN
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5276 BEACHFRONT COVE ST UNIT 234
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92154-5256
Mailing Address - Country:US
Mailing Address - Phone:760-554-7894
Mailing Address - Fax:
Practice Address - Street 1:3131 CAMINO DEL RIO N STE 860
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-5756
Practice Address - Country:US
Practice Address - Phone:619-317-1648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-22
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95010553363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty