MEDICARE: DR. MICHELLE 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	103TC0700X	Clinical Psychologist	PSY 27118	CA

General Provider Information

NPI Number	:	1982060729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHELLE LOPEZ

Provider Business Mailing Address
First Line	:	7860 MISSION CENTER CT
Second Line	:	209
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-1329
Country	:	US
Telephone Number	:	619-800-1566
Fax Number	:

Provider Business Practice Location Address
First Line	:	7860 MISSION CENTER CT
Second Line	:	209
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-1329
Country	:	US
Telephone Number	:	619-800-1566
Fax Number	:

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

Provider Enumeration Date	:	01/09/2016
Last Update Date	:	01/09/2016

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