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General NPI Number Information
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NPI Number | 1538718085
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Entity Type | Individual
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Provider Name | JOSE ANTONIO LOPEZ
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Gender | Male
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Dates
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Enumeration Date | 09/07/2019
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Last Update Date | 09/07/2019
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Provider Practice Location Address
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Address Line | 4760 OAKLAND ST STE 100
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City | DENVER
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State | CO
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Zip | 80239-2732
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Country | US
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Telephone | 810-289-9592
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Fax |
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Provider Business Mailing Address
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Address Line | 4760 OAKLAND ST STE 100
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City | DENVER
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State | CO
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Zip | 80239-2732
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Country | US
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Telephone | 818-345-2345
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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 |
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License Number State |
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