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NPI Code Detail

MEDICARE: YESENIA CARIDAD LOPEZ AA, CADC-I

MEDICARE: YESENIA CARIDAD LOPEZ AA, CADC-I
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
1101YA0400XAddiction (Substance Use Disorder) Counselor02024-INV
2101YP2500XProfessional CounselorCI3043NV

General Provider Information

NPI Number : 1821523515
Entity Type Code : Individual
Provider Name (Legal Business Name) : YESENIA CARIDAD LOPEZ AA, CADC-I
Provider Business Mailing Address
First Line : 3930 SHADOW WOOD AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89121-4536
Country : US
Telephone Number : 702-986-9695
Fax Number :
Provider Business Practice Location Address
First Line : 3675 PECOS MCLEOD STE 100
Second Line :
City : LAS VEGAS
State : NV
Zip : 89121-3811
Country : US
Telephone Number : 702-986-9695
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/01/2017
Last Update Date : 03/05/2022

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