Individual
JACQUELINE MARIE LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RPA-C
Contact information
Practice address
301 E MAIN ST, BAY SHORE, NY 11706-8408
(516) 521-3744
Mailing address
3 CLOVER LN, KINGS PARK, NY 11754-3914
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
23015496
NY
363AS0400X
Surgical Physician Assistant
—
—
Other
Enumeration date
03/15/2012
Last updated
06/13/2019
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