Individual
VANESSA KAYLA LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
IDC
Contact information
Practice address
34800 BOB WILSON DR, SAN DIEGO, CA 92134-1098
(619) 532-6400
Mailing address
239 EBONY AVE, IMPERIAL BEACH, CA 91932-2539
(402) 972-6248
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
08/19/2022
Last updated
02/03/2023
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