Healthcare Provider Details

I. General information

NPI: 1578907523
Provider Name (Legal Business Name): VICTOR LOPEZ JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2013
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78 TABLE MOUNTAIN BLVD
OROVILLE CA
95965-3578
US

IV. Provider business mailing address

2345 FLORIDA LN
DURHAM CA
95938-9622
US

V. Phone/Fax

Practice location:
  • Phone: 530-854-0022
  • Fax:
Mailing address:
  • Phone: 530-854-0022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW123560
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: