Healthcare Provider Details

I. General information

NPI: 1255250007
Provider Name (Legal Business Name): YVONNE MAURA LOPEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E 13TH ST
MERCED CA
95341-6211
US

IV. Provider business mailing address

3888 SOLSTICE AVE
MERCED CA
95348-8700
US

V. Phone/Fax

Practice location:
  • Phone: 209-446-3039
  • Fax:
Mailing address:
  • Phone: 209-446-3039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number225400000
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: