Healthcare Provider Details

I. General information

NPI: 1538785894
Provider Name (Legal Business Name): JOCELYNE LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2020
Last Update Date: 06/05/2024
Certification Date: 06/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 E 4500 S STE 300
MURRAY UT
84107-4502
US

IV. Provider business mailing address

650 E 4500 S STE 300
MURRAY UT
84107-4502
US

V. Phone/Fax

Practice location:
  • Phone: 801-261-3500
  • Fax:
Mailing address:
  • Phone: 801-261-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: