Individual
CASSONDRA ROSE LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1237 GREEN OAK RD, VISTA, CA 92081
(951) 306-6514
Mailing address
5276 ADAMS AVE, SAN DIEGO, CA 92115-3501
(951) 306-6514
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
21043
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
519423
MEDI-CAL DOCUMENT NUMBER
CA
Enumeration date
10/17/2012
Last updated
05/21/2019
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