Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0002X | Hospice and Palliative Medicine | 2019-01179 | NC |
NPI | 1356728364 |
---|---|
Provider Name | Dr. Victoria Lopez |
First Address | North Myrtle Beach, SC 29582-0439 |
Second Address | Myrtle Beach, SC 29588-7209 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2015 |
Last Update Date | 23/12/2021 |