Healthcare Provider Details

I. General information

NPI: 1093365025
Provider Name (Legal Business Name): EMILY LOPEZ-SANTOYO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2019
Last Update Date: 09/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1915 HOWARD RD STE B&C
MADERA CA
93637-5163
US

IV. Provider business mailing address

1832 MERCED ST APT 105
MADERA CA
93638-1743
US

V. Phone/Fax

Practice location:
  • Phone: 559-330-2211
  • Fax:
Mailing address:
  • Phone:
  • 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: