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NPI Code Detail

MEDICARE: MS. RACHEL GWENDOLYN LOPEZ AMFT 116402

MEDICARE: MS. RACHEL GWENDOLYN LOPEZ AMFT 116402
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
1106H00000XMarriage & Family Therapist116402CA

General Provider Information

NPI Number : 1588063093
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. RACHEL GWENDOLYN LOPEZ AMFT 116402
Provider Business Mailing Address
First Line : 1396 W HERNDON AVE
Second Line :
City : FRESNO
State : CA
Zip : 93711-7126
Country : US
Telephone Number : 559-326-8696
Fax Number :
Provider Business Practice Location Address
First Line : 1396 W HERNDON AVE
Second Line :
City : FRESNO
State : CA
Zip : 93711-7126
Country : US
Telephone Number : 559-256-4474
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/20/2014
Last Update Date : 08/23/2024

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