Healthcare Provider Details

I. General information

NPI: 1720425861
Provider Name (Legal Business Name): MS. SHARMAINE LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2013
Last Update Date: 03/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5275 VISTA BLVD STE A1
SPARKS NV
89436-0840
US

IV. Provider business mailing address

1725 S MCCARRAN BLVD
RENO NV
89502-9513
US

V. Phone/Fax

Practice location:
  • Phone: 775-530-9390
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: