Provider Demographics
NPI:1750005237
Name:LOPEZ, CLAUDIA VANESA (LE, PMUA)
Entity type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:VANESA
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:LE, PMUA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45200 CLUB DR
Mailing Address - Street 2:
Mailing Address - City:INDIAN WELLS
Mailing Address - State:CA
Mailing Address - Zip Code:92210-8837
Mailing Address - Country:US
Mailing Address - Phone:760-777-8772
Mailing Address - Fax:
Practice Address - Street 1:45200 CLUB DR
Practice Address - Street 2:
Practice Address - City:INDIAN WELLS
Practice Address - State:CA
Practice Address - Zip Code:92210-8837
Practice Address - Country:US
Practice Address - Phone:760-777-8772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-28
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAZ1472932255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer