Provider Demographics
NPI:1689439234
Name:LOPEZ, MARISSA KRISTINA
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:KRISTINA
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 1:157 S K ST
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-4011
Mailing Address - Country:US
Mailing Address - Phone:661-609-2128
Mailing Address - Fax:
Practice Address - Street 1:3549 S COUNTY CENTER DR
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-7172
Practice Address - Country:US
Practice Address - Phone:559-368-3810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA01270165376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide