Provider Demographics
NPI:1134467947
Name:LOPEZ, VIRGINIA CARMIN
Entity Type:Individual
Prefix:MISS
First Name:VIRGINIA
Middle Name:CARMIN
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4130 N LINCOLN BLVD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73105-5209
Mailing Address - Country:US
Mailing Address - Phone:405-523-3931
Mailing Address - Fax:405-523-3949
Practice Address - Street 1:4130 N LINCOLN BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITSY
Practice Address - State:OK
Practice Address - Zip Code:73105
Practice Address - Country:US
Practice Address - Phone:405-523-3937
Practice Address - Fax:405-523-3949
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-29
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health