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NPI Code Detail

MEDICARE: DAISY LOPEZ JIMENEZ

MEDICARE: DAISY LOPEZ JIMENEZ
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1396459814
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAISY LOPEZ JIMENEZ
Provider Business Mailing Address
First Line : 1200 CONCORD AVE STE 100
Second Line :
City : CONCORD
State : CA
Zip : 94520-4969
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1200 CONCORD AVE STE 100
Second Line :
City : CONCORD
State : CA
Zip : 94520-4969
Country : US
Telephone Number : 925-440-1928
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/09/2023
Last Update Date : 01/09/2023

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Directions to “ DAISY LOPEZ JIMENEZ ” Practice Location

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