Provider Demographics
NPI:1528392925
Name:LOPEZ, JOHN THOMAS
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:THOMAS
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 1:42145 LYNDIE LN
Mailing Address - Street 2:SUITE# 102
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-3612
Mailing Address - Country:US
Mailing Address - Phone:951-699-4906
Mailing Address - Fax:951-587-2625
Practice Address - Street 1:42145 LYNDIE LN
Practice Address - Street 2:SUITE# 102
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-3612
Practice Address - Country:US
Practice Address - Phone:951-699-4906
Practice Address - Fax:951-587-2625
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-01
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor