MEDICARE: TYLER LOPEZ

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	22489	CA

General Provider Information

NPI Number	:	1841142908
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYLER LOPEZ

Provider Business Mailing Address
First Line	:	200 W MARIPOSA AVE
Second Line	:
City	:	RIDGECREST
State	:	CA
Zip	:	93555-5008
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	424 CHRISTOPHER CT
Second Line	:
City	:	RIDGECREST
State	:	CA
Zip	:	93555-6009
Country	:	US
Telephone Number	:	760-800-4325
Fax Number	:	760-239-7601

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

Provider Enumeration Date	:	02/11/2026
Last Update Date	:	02/11/2026

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Directions to “ TYLER LOPEZ ” Practice Location

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