1811566086 NPI number — CYNTHIA ILIANA LOPEZ PHARMACY TECHNICIAN

Table of content: CYNTHIA ILIANA LOPEZ PHARMACY TECHNICIAN (NPI 1811566086)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811566086 NPI number — CYNTHIA ILIANA LOPEZ PHARMACY TECHNICIAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOPEZ
Provider First Name:
CYNTHIA
Provider Middle Name:
ILIANA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHARMACY TECHNICIAN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LOPEZ
Provider Other First Name:
CYNTHIA
Provider Other Middle Name:
ILIANA
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHARMACY TECHNICIAN
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1811566086
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/22/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
661 SWEETWATER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRING VALLEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91977-5628
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-463-9848
Provider Business Mailing Address Fax Number:
619-463-9828

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
661 SWEETWATER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRING VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91977-5628
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-463-9848
Provider Business Practice Location Address Fax Number:
619-463-9828
Provider Enumeration Date:
06/22/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183700000X , with the licence number:  37624 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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