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General NPI Number Information
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NPI Number | 1437095585
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Entity Type | Individual
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Provider Name | JACOB LOPEZ GARCIA
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Gender | Male
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Dates
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Enumeration Date | 04/28/2026
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Last Update Date | 04/28/2026
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Provider Practice Location Address
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Address Line | 17 W RED BANK AVE STE 103
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City | WOODBURY
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State | NJ
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Zip | 08096-1630
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Country | US
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Telephone | 856-480-0688
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Fax |
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Provider Business Mailing Address
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Address Line | 28 SHERMAN AVE
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City | TRENTON
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State | NJ
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Zip | 08638-3455
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Country | US
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Telephone | 609-533-0767
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | BACB1447900
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License Number State | NJ
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