MEDICARE: VICTOR LOPEZ JR.

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1578907523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTOR LOPEZ JR.

Provider Business Mailing Address
First Line	:	68 TARA TER APT 2
Second Line	:
City	:	CHICO
State	:	CA
Zip	:	95973-0894
Country	:	US
Telephone Number	:	530-898-9806
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 DECLARATION DR
Second Line	:
City	:	CHICO
State	:	CA
Zip	:	95973-4902
Country	:	US
Telephone Number	:	530-893-4784
Fax Number	:

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

Provider Enumeration Date	:	04/22/2013
Last Update Date	:	04/22/2013

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