Provider Demographics
NPI:1255055778
Name:LOPEZ, SANDRA YAMILET
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:YAMILET
Last Name:LOPEZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15934 W E ST
Mailing Address - Street 2:
Mailing Address - City:KERMAN
Mailing Address - State:CA
Mailing Address - Zip Code:93630-1247
Mailing Address - Country:US
Mailing Address - Phone:209-596-3637
Mailing Address - Fax:
Practice Address - Street 1:90 W ASHLAN AVE STE 100
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-5627
Practice Address - Country:US
Practice Address - Phone:209-596-3637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-28
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker