MEDICARE: DR. MARCOS DAMIAN LOPEZ PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TB0200X	Cognitive & Behavioral Psychologist	PSY-25939	CA
2	103TC0700X	Clinical Psychologist	PSY-25939	CA

General Provider Information

NPI Number	:	1336468925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARCOS DAMIAN LOPEZ PH.D.

Provider Business Mailing Address
First Line	:	8850 WILLIAMSON DR UNIT 2079
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95759-4063
Country	:	US
Telephone Number	:	916-702-8750
Fax Number	:	916-720-0590

Provider Business Practice Location Address
First Line	:	9403 AIZENBERG CIR
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95624-1662
Country	:	US
Telephone Number	:	916-702-8750
Fax Number	:	916-720-0590

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2010
Last Update Date	:	08/09/2024

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