Healthcare Provider Details

I. General information

NPI: 1225556814
Provider Name (Legal Business Name): LUIS LOPEZ-ALEJANDRE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2017
Last Update Date: 04/19/2023
Certification Date: 04/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2155 IRON POINT RD
FOLSOM CA
95630-8707
US

IV. Provider business mailing address

2155 IRON POINT RD
FOLSOM CA
95630-8707
US

V. Phone/Fax

Practice location:
  • Phone: 916-973-5300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberD6477897
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLCSW107999
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: