Provider Demographics
NPI:1578763710
Name:LOPEZ, VALENTIN (COUNSELOR)
Entity Type:Individual
Prefix:
First Name:VALENTIN
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24384 SUNNYMEAD BLVD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-3069
Mailing Address - Country:US
Mailing Address - Phone:951-243-0303
Mailing Address - Fax:951-243-3006
Practice Address - Street 1:24384 SUNNYMEAD BLVD
Practice Address - Street 2:SUITE 240
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-3069
Practice Address - Country:US
Practice Address - Phone:951-243-0303
Practice Address - Fax:951-243-3006
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16161101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)