MEDICARE: AFRODESIA C LOPOZ

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	310400000X	Assisted Living Facility	5713010	NV

General Provider Information

NPI Number	:	1912565557
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AFRODESIA C LOPOZ

Provider Business Mailing Address
First Line	:	1149 FAIR WEATHER CIR
Second Line	:
City	:	CONCORD
State	:	CA
Zip	:	94518-1939
Country	:	US
Telephone Number	:	925-483-1096
Fax Number	:	925-955-9000

Provider Business Practice Location Address
First Line	:	1807 E LONG ST
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89706-3214
Country	:	US
Telephone Number	:	775-883-4449
Fax Number	:	775-883-4403

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

Provider Enumeration Date	:	05/29/2019
Last Update Date	:	05/29/2019

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Directions to “ AFRODESIA C LOPOZ ” Practice Location

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