Provider Demographics
NPI:1558831578
Name:LOPEZ, LIBERTAD ESMERALDA
Entity Type:Individual
Prefix:
First Name:LIBERTAD
Middle Name:ESMERALDA
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 BELMONT AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:MENDOTA
Mailing Address - State:CA
Mailing Address - Zip Code:93640-8231
Mailing Address - Country:US
Mailing Address - Phone:855-343-1057
Mailing Address - Fax:
Practice Address - Street 1:121 BELMONT AVE STE 300
Practice Address - Street 2:
Practice Address - City:MENDOTA
Practice Address - State:CA
Practice Address - Zip Code:93640-8231
Practice Address - Country:US
Practice Address - Phone:855-343-1057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-03
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator