MEDICARE: MR. OMAR ISRAEL LOPEZ ASW

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	104100000X	Social Worker	ASW109866	CA
2	1041C0700X	Clinical Social Worker	ASW109866	CA

General Provider Information

NPI Number	:	1861537854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. OMAR ISRAEL LOPEZ ASW

Provider Business Mailing Address
First Line	:	1055 W HENDERSON AVE STE 2
Second Line	:
City	:	PORTERVILLE
State	:	CA
Zip	:	93257-1490
Country	:	US
Telephone Number	:	559-788-1200
Fax Number	:	559-749-9772

Provider Business Practice Location Address
First Line	:	1055 W HENDERSON AVE STE 2
Second Line	:
City	:	PORTERVILLE
State	:	CA
Zip	:	93257-1490
Country	:	US
Telephone Number	:	559-788-1200
Fax Number	:	559-749-9772

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

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	09/24/2025

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