Provider Demographics
NPI:1366856304
Name:LOPEZ, MARCO OLIVER DUGAN (DNP, FNP, PMHNP)
Entity type:Individual
Prefix:
First Name:MARCO OLIVER
Middle Name:DUGAN
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:DNP, FNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 PARNASSUS AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-2204
Mailing Address - Country:US
Mailing Address - Phone:415-476-7730
Mailing Address - Fax:415-476-7320
Practice Address - Street 1:505 PARNASSUS AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-2204
Practice Address - Country:US
Practice Address - Phone:415-476-7730
Practice Address - Fax:415-476-7320
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-18
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95000845363LP0808X, 363LP2300X
CA716471163WP2201X, 163W00000X
CA95000854363L00000X, 363LF0000X
CA2015009739363LP0808X
CA2013001613163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95000854OtherCALIFORNIA BOARD OF REGISTERED NURSING NP FURNISHING#
CA75207OtherCALIFORNIA BOARD OF REGISTERED NURSING PHN#
CA95000854OtherCALIFORNIA BOARD OF REGISTERED NURSING NP#
CA716471OtherCALIFORNIA BOARD OF REGISTERED NURSING RN#