Provider Demographics
NPI:1598139156
Name:LOPEZ, LANI (CASI)
Entity Type:Individual
Prefix:
First Name:LANI
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:CASI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2843 FILBERT ST
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-7335
Mailing Address - Country:US
Mailing Address - Phone:925-222-9803
Mailing Address - Fax:
Practice Address - Street 1:904 MELLUS ST
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-1745
Practice Address - Country:US
Practice Address - Phone:925-229-0230
Practice Address - Fax:925-229-0233
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-19
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)