Provider Demographics
NPI:1750333613
Name:LOPEZ, ANNE MICHELE (PA)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:MICHELE
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 OCEAN WALK CT
Mailing Address - Street 2:
Mailing Address - City:PORT HUENEME
Mailing Address - State:CA
Mailing Address - Zip Code:93041-3224
Mailing Address - Country:US
Mailing Address - Phone:805-901-7045
Mailing Address - Fax:
Practice Address - Street 1:BLDG 1145 STURGIS STREET
Practice Address - Street 2:NAVAL HOSPITAL ATTN PROFESSIONAL AFFAIRS
Practice Address - City:TWENTYNINE PALMS
Practice Address - State:CA
Practice Address - Zip Code:92278-8252
Practice Address - Country:US
Practice Address - Phone:760-830-2617
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1038372363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Not Answered363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical