Provider Demographics
NPI:1407373533
Name:GARCIA LOPEZ, LUIS ANDRES
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:ANDRES
Last Name:GARCIA 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 1:3500 LAKESIDE CT STE 101
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-4862
Mailing Address - Country:US
Mailing Address - Phone:775-786-6880
Mailing Address - Fax:
Practice Address - Street 1:3500 LAKESIDE CT., #101
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509
Practice Address - Country:US
Practice Address - Phone:775-786-6880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician