Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 95003941 | CA |
N | 363LX0001X | Nurse Practitioner - Obstetrics & Gynecology | 95003941 | CA |
NPI | 1063867158 |
---|---|
Provider Name | Trisha Mendoza Lopez |
First Address | Clackamas, OR 97015-8970 |
Second Address | Clackamas, OR 97015-8970 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2016 |
Last Update Date | 17/12/2021 |