MEDICARE: STEPHANIE M LOPEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	171M00000X	Case Manager/Care Coordinator
3	101Y00000X	Counselor

General Provider Information

NPI Number	:	1598269169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE M LOPEZ

Provider Business Mailing Address
First Line	:	1026 VICTORIES LOOP
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95116-2274
Country	:	US
Telephone Number	:	669-258-1366
Fax Number	:

Provider Business Practice Location Address
First Line	:	1026 VICTORIES LOOP
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95116-2274
Country	:	US
Telephone Number	:	669-258-1366
Fax Number	:

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

Provider Enumeration Date	:	03/20/2018
Last Update Date	:	03/20/2018

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