Healthcare Provider Details

I. General information

NPI: 1285039875
Provider Name (Legal Business Name): STEPHANIE KAY LOPEZ PSYCH TECH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2014
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1904 RICHLAND AVE
CERES CA
95307-4562
US

IV. Provider business mailing address

1904 RICHLAND AVE
CERES CA
95307-4562
US

V. Phone/Fax

Practice location:
  • Phone: 209-300-8800
  • Fax: 209-300-8898
Mailing address:
  • Phone: 209-300-8800
  • Fax: 209-300-8898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License Number42480
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: