Provider Demographics
NPI:1982141453
Name:LOPEZ, YVONNE (LAC)
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2031 N CAPELLA CT
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-3543
Mailing Address - Country:US
Mailing Address - Phone:323-377-6465
Mailing Address - Fax:
Practice Address - Street 1:4030 BIRCH ST
Practice Address - Street 2:UNIT 107
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2214
Practice Address - Country:US
Practice Address - Phone:323-377-6465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-23
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC11852171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist