Provider Demographics
NPI:1639640030
Name:LOPEZ, AGNES ADOLUVNI (RN)
Entity Type:Individual
Prefix:
First Name:AGNES ADOLUVNI
Middle Name:
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 1:5715 MUSICK AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:CA
Mailing Address - Zip Code:94560-2554
Mailing Address - Country:US
Mailing Address - Phone:510-818-4146
Mailing Address - Fax:
Practice Address - Street 1:5715 MUSICK AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:CA
Practice Address - Zip Code:94560-2554
Practice Address - Country:US
Practice Address - Phone:510-818-4146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-10
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA741684163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool