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NPI Code Detail

MEDICARE: MAYRA MELLO FONTAN VICTOR M LOPES

MEDICARE: MAYRA MELLO FONTAN VICTOR M LOPES
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
1235Z00000XSpeech-Language Pathologist40556CA

General Provider Information

NPI Number : 1548111438
Entity Type Code : Individual
Provider Name (Legal Business Name) : MAYRA MELLO FONTAN VICTOR M LOPES
Provider Business Mailing Address
First Line : 726 4TH ST
Second Line :
City : MARYSVILLE
State : CA
Zip : 95901-5656
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 726 4TH ST
Second Line :
City : MARYSVILLE
State : CA
Zip : 95901-5656
Country : US
Telephone Number : 530-751-4270
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/05/2026
Last Update Date : 02/05/2026

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Directions to “ MAYRA MELLO FONTAN VICTOR M LOPES ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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