Provider Demographics
NPI:1629822101
Name:LOPEZ, JENNA
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2276 FLATBUSH AVE # 2R
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-4518
Mailing Address - Country:US
Mailing Address - Phone:917-859-4704
Mailing Address - Fax:718-734-2499
Practice Address - Street 1:2276 FLATBUSH AVE # 2R
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-4518
Practice Address - Country:US
Practice Address - Phone:917-859-4704
Practice Address - Fax:718-734-2499
Is Sole Proprietor?:No
Enumeration Date:2024-04-12
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy