Ms Jackeline Beatriz Lopez, PA-C, RDN is a medicare enrolled "Physician Assistant" provider in Fontana, California. Her current practice location is
16465 Sierra Lakes Pkwy Ste 300, Fontana, California. You can reach out to her office (for appointments etc.) via phone at
(909) 429-2864.
Ms Jackeline Beatriz Lopez is licensed to practice in California (license number 62965) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1295246692.
Healthcare Provider's Profile
| Full Name | Ms Jackeline Beatriz Lopez |
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| Gender | Female |
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| Speciality | Physician Assistant |
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| Location | 16465 Sierra Lakes Pkwy Ste 300, Fontana, California |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1295246692
- Provider Enumeration Date: 10/12/2017
- Last Update Date: 08/01/2023
Medicare PECOS Information:
- PECOS PAC ID: 9931563236
- Enrollment ID: I20230919002533
Medical Identifiers
Medical identifiers for Ms Jackeline Beatriz Lopez such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1295246692 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 133V00000X | Dietitian, Registered | 86026975 (California) | Secondary |
| 133VN1005X | Dietitian, Registered - Nutrition, Renal | 86026975 (California) | Secondary |
| 390200000X | Student In An Organized Health Care Education/training Program | (* (Not Available)) | Secondary |
| 363A00000X | Physician Assistant | 62965 (California) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Ms Jackeline Beatriz Lopez is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Ms Jackeline Beatriz Lopez, PA-C, RDN
16465 Sierra Lakes Pkwy Ste 300,
Fontana, CA 92336-1242
Ph: (909) 429-2864 | Ms Jackeline Beatriz Lopez, PA-C, RDN
16465 Sierra Lakes Pkwy Ste 300,
Fontana, CA 92336-1242
Ph: (909) 429-2864 |
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