Individual
ANNALISE AYESHA LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LVN
Contact information
Practice address
820 E GILBERT ST, SAN BERNARDINO, CA 92415-3678
(909) 387-7200
Mailing address
820 E GILBERT ST, SAN BERNARDINO, CA 92415-0928
(909) 387-7200
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
737399
CA
Other
Enumeration date
11/27/2023
Last updated
11/05/2024
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