Provider Demographics
NPI:1518473990
Name:LOPEZ, KATRINA MARIE
Entity type:Individual
Prefix:MS
First Name:KATRINA
Middle Name:MARIE
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:KATRINA
Other - Middle Name:MARIE
Other - Last Name:TOVSRUD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:824 W ALAMOS AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93705-0513
Mailing Address - Country:US
Mailing Address - Phone:559-999-2512
Mailing Address - Fax:
Practice Address - Street 1:90 W ASHLAN AVE STE 100
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-5627
Practice Address - Country:US
Practice Address - Phone:559-882-5591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-20
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator