Provider Demographics
NPI:1902445968
Name:LOPEZ, CARINA CRYSTAL (WHNP)
Entity Type:Individual
Prefix:
First Name:CARINA
Middle Name:CRYSTAL
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:CARINA
Other - Middle Name:CRYSTAL
Other - Last Name:CORTEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:WHNP
Mailing Address - Street 1:3638 DEL AMO BLVD APT E
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-1621
Mailing Address - Country:US
Mailing Address - Phone:310-367-0013
Mailing Address - Fax:
Practice Address - Street 1:2284 E MAPLE AVE
Practice Address - Street 2:
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-6507
Practice Address - Country:US
Practice Address - Phone:424-244-3627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-22
Last Update Date:2019-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95013425363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Multi-Specialty