Provider Demographics
NPI:1508807629
Name:LOPEZ, CAROLYN MARIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:MARIA
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:35400 BOB HOPE DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-1708
Mailing Address - Country:US
Mailing Address - Phone:760-328-7500
Mailing Address - Fax:760-328-0044
Practice Address - Street 1:35400 BOB HOPE DR
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-1708
Practice Address - Country:US
Practice Address - Phone:950-609-7267
Practice Address - Fax:760-328-0044
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20762103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist