Healthcare Provider Details

I. General information

NPI: 1801246707
Provider Name (Legal Business Name): HILDA LOPEZ M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2016
Last Update Date: 10/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3219 PIERCE ST
RICHMOND CA
94804-5910
US

IV. Provider business mailing address

1207 MELVILLE SQ APT 416
RICHMOND CA
94804-4568
US

V. Phone/Fax

Practice location:
  • Phone: 510-559-5550
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number3358
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: