Individual
MRS. HEIDI ROTH LOPEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
812 4TH ST, SUITE A, MARYSVILLE, CA 95901-5667
(530) 741-3937
(530) 741-2109
Mailing address
4908 REGAL CT, ROCKLIN, CA 95765-5025
(916) 300-8852
(916) 663-6758
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
2184
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5839834
MEDI-CAL /EDS
CA
01
—
CGP170273
DHS / CCS
CA
Enumeration date
10/04/2006
Last updated
02/11/2022
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