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NPI Code Detail

MEDICARE: TERESA LOPEZ

MEDICARE: TERESA LOPEZ
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1578005914
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERESA LOPEZ
Provider Business Mailing Address
First Line : 160 E VIRGINIA ST
Second Line :
City : SAN JOSE
State : CA
Zip : 95112
Country : US
Telephone Number : 408-918-2618
Fax Number :
Provider Business Practice Location Address
First Line : 2600 S EL CAMINO REAL STE 200
Second Line :
City : SAN MATEO
State : CA
Zip : 94403-2382
Country : US
Telephone Number : 650-578-8691
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/16/2016
Last Update Date : 07/26/2017

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Directions to “ TERESA LOPEZ ” Practice Location

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