Provider Demographics
NPI:1538381348
Name:LOPEZ, CHANEL RAMONA
Entity type:Individual
Prefix:MRS
First Name:CHANEL
Middle Name:RAMONA
Last Name:LOPEZ
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 1:1512 REGULUS DRIVE
Mailing Address - Street 2:
Mailing Address - City:POINT MUGU
Mailing Address - State:CA
Mailing Address - Zip Code:93041
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1305 DEL NORTE ROAD
Practice Address - Street 2:SUITE 130
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-8366
Practice Address - Country:US
Practice Address - Phone:805-485-6114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program