Individual
JACKELINE LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGNP- PCP, MSN
Contact information
Practice address
1250 16TH ST, SANTA MONICA, CA 90404-1249
(310) 825-9111
Mailing address
5594 VALENCIA DR, MONTCLAIR, CA 91762-7648
(760) 217-9258
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
95100221
CA
Other
Enumeration date
07/10/2024
Last updated
07/10/2024
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