Provider Demographics
NPI:1164718581
Name:LOPEZ, JOSE HIGAREDA (COUNSELOR)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:HIGAREDA
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4141 FERN GROVE CT
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356
Mailing Address - Country:US
Mailing Address - Phone:650-355-8787
Mailing Address - Fax:650-355-8780
Practice Address - Street 1:480 MANOR PLAZA
Practice Address - Street 2:
Practice Address - City:PACIFICA
Practice Address - State:CA
Practice Address - Zip Code:94044
Practice Address - Country:US
Practice Address - Phone:650-355-8787
Practice Address - Fax:650-355-8780
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)