Provider Demographics
NPI:1235777699
Name:LOPEZ, GIORGIO ANTONIO
Entity Type:Individual
Prefix:
First Name:GIORGIO
Middle Name:ANTONIO
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4713 CURLETTO DR
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94521-2125
Mailing Address - Country:US
Mailing Address - Phone:717-515-5836
Mailing Address - Fax:
Practice Address - Street 1:2975 TREAT BLVD STE B5
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94518-3687
Practice Address - Country:US
Practice Address - Phone:510-236-3139
Practice Address - Fax:510-236-3200
Is Sole Proprietor?:No
Enumeration Date:2019-12-17
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)