Healthcare Provider Details

I. General information

NPI: 1669671699
Provider Name (Legal Business Name): FREDERICK LOPEZ PSYD, LP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2007
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31573 RANCHO PUEBLO RD STE 200
TEMECULA CA
92592-4854
US

IV. Provider business mailing address

31573 RANCHO PUEBLO RD STE 200
TEMECULA CA
92592-4854
US

V. Phone/Fax

Practice location:
  • Phone: 858-279-1223
  • Fax:
Mailing address:
  • Phone: 858-279-1223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number32140
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: