Healthcare Provider Details

I. General information

NPI: 1023519303
Provider Name (Legal Business Name): ARMANDO LOPEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2018
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1581 CUMMINS DR STE B
MODESTO CA
95358-6402
US

IV. Provider business mailing address

3041 SARIYA WAY
CERES CA
95307-9202
US

V. Phone/Fax

Practice location:
  • Phone: 209-492-5113
  • Fax: 209-574-1541
Mailing address:
  • Phone: 209-416-8651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number3D26ECD19F
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-19-36295
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: