Individual
MARIA E. LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
6200 VAN BUREN BLVD, RIVERSIDE, CA 92503-2098
(951) 358-0255
(951) 358-0218
Mailing address
11711 COLLETT AVE APT 2526, RIVERSIDE, CA 92505-3790
(909) 815-4227
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA21391
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA 21391
DEPARTMENT OF CONSUMER AFFAIR
CA
Enumeration date
02/28/2011
Last updated
12/06/2016
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