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General NPI Number Information
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NPI Number | 1760272975
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Entity Type | Individual
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Provider Name | MANUEL LOPEZ RD
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Gender | Male
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Dates
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Enumeration Date | 05/09/2025
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Last Update Date | 05/09/2025
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Provider Practice Location Address
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Address Line | 4301 X ST
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City | SACRAMENTO
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State | CA
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Zip | 95817-2214
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Country | US
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Telephone | 916-734-2011
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Fax |
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Provider Business Mailing Address
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Address Line | 2421 W ST APT 8
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City | SACRAMENTO
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State | CA
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Zip | 95818-1857
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Country | US
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Telephone | 805-815-8693
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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 | 133VN1004X
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Taxonomy Name | Pediatric Nutrition Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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