Provider Demographics
NPI:1225241771
Name:AVALOS, SANDRA LOPEZ (MSW)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:LOPEZ
Last Name:AVALOS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2142
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93438-2142
Mailing Address - Country:US
Mailing Address - Phone:805-740-1404
Mailing Address - Fax:
Practice Address - Street 1:1133 N H ST
Practice Address - Street 2:SUITE F
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-3368
Practice Address - Country:US
Practice Address - Phone:805-740-1404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker