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NPI Code Detail

MEDICARE: DR. ERENDIRA LOPEZ-GARCIA PSYD

MEDICARE: DR. ERENDIRA LOPEZ-GARCIA PSYD
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
1103TC0700XClinical Psychologist6212OH

General Provider Information

NPI Number : 1689769580
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ERENDIRA LOPEZ-GARCIA PSYD
Provider Business Mailing Address
First Line : P.O. BOX 341648
Second Line :
City : DAYTON
State : OH
Zip : 45434
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1020 WOODMAN DR STE 300
Second Line :
City : DAYTON
State : OH
Zip : 45432-1410
Country : US
Telephone Number : 937-254-9210
Fax Number : 937-254-9267
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2006
Last Update Date : 06/22/2015

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