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NPI Code Detail

MEDICARE: MR. MAURICIO LOPEZ-MOLINA IMFT

MEDICARE: MR. MAURICIO LOPEZ-MOLINA IMFT
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 Therapist

General Provider Information

NPI Number : 1629192034
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MAURICIO LOPEZ-MOLINA IMFT
Provider Business Mailing Address
First Line : 1650 LAS PLUMAS AVE STE K
Second Line :
City : SAN JOSE
State : CA
Zip : 95133-1657
Country : US
Telephone Number : 408-272-6739
Fax Number : 408-259-0865
Provider Business Practice Location Address
First Line : 1650 LAS PLUMAS AVE STE K
Second Line :
City : SAN JOSE
State : CA
Zip : 95133-1657
Country : US
Telephone Number : 408-272-6726
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/19/2007
Last Update Date : 07/08/2007

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