Provider Demographics
NPI:1518729862
Name:LOPEZ SIQUEIROS, FERNANDA AICHEL
Entity type:Individual
Prefix:
First Name:FERNANDA
Middle Name:AICHEL
Last Name:LOPEZ SIQUEIROS
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:PO BOX 7278
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92248-7278
Mailing Address - Country:US
Mailing Address - Phone:760-564-9205
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 7278
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92248-7278
Practice Address - Country:US
Practice Address - Phone:760-564-9205
Practice Address - Fax:760-771-6215
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-23
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker