MEDICARE: MS. MARIVEL RODRIGUEZ LOPEZ LMFT

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	106H00000X	Marriage & Family Therapist	85047	CA

General Provider Information

NPI Number	:	1902936792
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARIVEL RODRIGUEZ LOPEZ LMFT

Provider Business Mailing Address
First Line	:	18525 SUTTER BLVD STE 200
Second Line	:
City	:	MORGAN HILL
State	:	CA
Zip	:	95037-2899
Country	:	US
Telephone Number	:	408-762-7022
Fax Number	:

Provider Business Practice Location Address
First Line	:	4612 ROOSEVELT AVE
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95820-4520
Country	:	US
Telephone Number	:	916-379-5876
Fax Number	:	916-407-0208

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

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	02/11/2022

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