Provider Demographics
NPI:1174107320
Name:LOPEZ MARTINEZ, YADIRA IN YAMECH
Entity type:Individual
Prefix:
First Name:YADIRA
Middle Name:IN YAMECH
Last Name:LOPEZ MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6405 MIRA MESA BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-4146
Mailing Address - Country:US
Mailing Address - Phone:866-701-6565
Mailing Address - Fax:
Practice Address - Street 1:6405 MIRA MESA BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-4147
Practice Address - Country:US
Practice Address - Phone:855-975-8321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA115745183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician