Provider Demographics
NPI:1245756865
Name:LOPEZ, JULIAN LEONARDO
Entity Type:Individual
Prefix:
First Name:JULIAN
Middle Name:LEONARDO
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 1:5725 CANOE DR
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:92880-7248
Mailing Address - Country:US
Mailing Address - Phone:951-833-5962
Mailing Address - Fax:
Practice Address - Street 1:5725 CANOE DR
Practice Address - Street 2:
Practice Address - City:EASTVALE
Practice Address - State:CA
Practice Address - Zip Code:92880-7248
Practice Address - Country:US
Practice Address - Phone:951-833-5962
Practice Address - Fax:951-833-5962
Is Sole Proprietor?:No
Enumeration Date:2017-08-15
Last Update Date:2017-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician