Provider Demographics
NPI:1336468925
Name:LOPEZ, MARCOS DAMIAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARCOS
Middle Name:DAMIAN
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8850 WILLIAMSON DR UNIT 2079
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95759-4063
Mailing Address - Country:US
Mailing Address - Phone:916-702-8750
Mailing Address - Fax:916-720-0590
Practice Address - Street 1:8850 WILLIAMSON DR UNIT 2079
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95759-4063
Practice Address - Country:US
Practice Address - Phone:916-702-8750
Practice Address - Fax:916-720-0590
Is Sole Proprietor?:No
Enumeration Date:2010-05-22
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY-25939103TB0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral