Provider Demographics
NPI:1427397439
Name:LOPEZ, GENE STEVE
Entity Type:Individual
Prefix:
First Name:GENE
Middle Name:STEVE
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 1:255 FLINT ST
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-3616
Mailing Address - Country:US
Mailing Address - Phone:801-529-4698
Mailing Address - Fax:
Practice Address - Street 1:255 FLINT ST
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-3616
Practice Address - Country:US
Practice Address - Phone:801-529-4698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-11
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency