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NPI Code Detail

MEDICARE: MR. ROMAN LOPEZ

MEDICARE:  MR. ROMAN  LOPEZ
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
1101YM0800XMental Health Counselor1041C0700XNV
2171M00000XCase Manager/Care Coordinator

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1265701098
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ROMAN LOPEZ
Provider Business Mailing Address
First Line : 1640 E FLAMINGO RD
Second Line : #100
City : LAS VEGAS
State : NV
Zip : 89119-5249
Country : US
Telephone Number : 702-369-4357
Fax Number :
Provider Business Practice Location Address
First Line : 1640 E FLAMINGO RD
Second Line : #100
City : LAS VEGAS
State : NV
Zip : 89119-5249
Country : US
Telephone Number : 702-369-4357
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/22/2011
Last Update Date : 02/18/2014

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