Healthcare Provider Details

I. General information

NPI: 1558601625
Provider Name (Legal Business Name): REYNALDO SOSA LOPEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2013
Last Update Date: 02/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1127 BALDWIN ST
SALINAS CA
93906-3681
US

IV. Provider business mailing address

1127 BALDWIN ST
SALINAS CA
93906-3681
US

V. Phone/Fax

Practice location:
  • Phone: 831-261-5612
  • Fax: 831-444-9636
Mailing address:
  • Phone: 831-261-5612
  • Fax: 831-444-9636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: