Provider Demographics
NPI:1225587520
Name:LOPEZ, TANIA MELISSA
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:MELISSA
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 1:15373 INNOVATION DR STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-3425
Mailing Address - Country:US
Mailing Address - Phone:858-699-7579
Mailing Address - Fax:
Practice Address - Street 1:15373 INNOVATION DR STE 200
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-3425
Practice Address - Country:US
Practice Address - Phone:858-699-7579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-27
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst