Provider Demographics
NPI:1730930488
Name:LOPEZ, JOE DAVID (RN)
Entity type:Individual
Prefix:
First Name:JOE
Middle Name:DAVID
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67871 RIO PECOS DR
Mailing Address - Street 2:
Mailing Address - City:CATHEDRAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92234-8644
Mailing Address - Country:US
Mailing Address - Phone:361-549-1997
Mailing Address - Fax:
Practice Address - Street 1:67871 RIO PECOS DR
Practice Address - Street 2:
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234-8644
Practice Address - Country:US
Practice Address - Phone:361-549-1997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95308717163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse