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General NPI Number Information
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NPI Number | 1356947451
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Entity Type | Individual
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Provider Name | JAVIER LOPEZ JR. C.M.T.
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Gender | Male
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Dates
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Enumeration Date | 12/05/2020
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Last Update Date | 12/05/2020
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Provider Practice Location Address
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Address Line | 1231 40TH ST APT 231
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City | EMERYVILLE
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State | CA
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Zip | 94608-3671
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Country | US
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Telephone | 415-691-9431
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Fax |
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Provider Business Mailing Address
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Address Line | 1890 OREGANO WAY
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City | TRACY
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State | CA
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Zip | 95376-6727
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Country | US
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Telephone | 415-574-0711
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 1268
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License Number State | CA
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