| Doctor Name: | SANDRA LOPEZ |
| NPI Number: | 1174908396 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 1150 Fremont Blvd Seaside, CA - 939555715 |
| Business Phone Number: | 8318998100 |
| Business Fax Number: | 8318998105 |
| Mailing Address: | 1150 Fremont Blvd, SEASIDE |
| State: | CA |
| Postal Code: | 939555715 |
| Phone Number: | 8318998100 |
| Fax Number: | 8318998105 |
| NPI Enumeration Date: | 07/29/2015 |
| NPI Last Update Date: | 07/29/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QF0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Federally Qualified Health Center (FQHC) |
| Taxonomy Definition: | |