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NPI Code Detail

MEDICARE: MS. NICOLE V LOPEZ M.S.

MEDICARE: MS. NICOLE V LOPEZ M.S.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist44736CA
2106H00000XMarriage & Family Therapist90791CA

General Provider Information

NPI Number : 1255524815
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. NICOLE V LOPEZ M.S.
Provider Business Mailing Address
First Line : 130 W VICTORIA ST
Second Line :
City : GARDENA
State : CA
Zip : 90248-3523
Country : US
Telephone Number : 909-428-2366
Fax Number :
Provider Business Practice Location Address
First Line : 15217 SAN BERNARDINO AVE
Second Line :
City : FONTANA
State : CA
Zip : 92335-5327
Country : US
Telephone Number : 951-643-2150
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/27/2007
Last Update Date : 10/07/2020

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