Provider Demographics
NPI:1013109693
Name:LOPEZ, ALBERTO ACEVESL (FNP)
Entity type:Individual
Prefix:MR
First Name:ALBERTO
Middle Name:ACEVESL
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 1:678 SAGEBRUSH ST
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL
Mailing Address - State:CA
Mailing Address - Zip Code:92251-8920
Mailing Address - Country:US
Mailing Address - Phone:760-562-7739
Mailing Address - Fax:760-348-6032
Practice Address - Street 1:7018 BLAIR RD
Practice Address - Street 2:
Practice Address - City:CALIPATRIA
Practice Address - State:CA
Practice Address - Zip Code:92233-9633
Practice Address - Country:US
Practice Address - Phone:760-348-7000
Practice Address - Fax:760-348-6032
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-16
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN469417 NP14065363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily