Healthcare Provider Details

I. General information

NPI: 1023908142
Provider Name (Legal Business Name): RIGOBERTO C LOPEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2025
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82380 MILES AVE
INDIO CA
92201-2608
US

IV. Provider business mailing address

100120 ROCKY POINT DR
MECCA CA
92254-4092
US

V. Phone/Fax

Practice location:
  • Phone: 800-207-0272
  • Fax:
Mailing address:
  • Phone: 442-484-0755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: