Provider Demographics
NPI:1619222734
Name:LOPEZ, ERIC ROBERTO (MA)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:ROBERTO
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4319 W 156TH ST
Mailing Address - Street 2:
Mailing Address - City:LAWNDALE
Mailing Address - State:CA
Mailing Address - Zip Code:90260-2126
Mailing Address - Country:US
Mailing Address - Phone:424-800-1599
Mailing Address - Fax:
Practice Address - Street 1:4319 W 156TH ST
Practice Address - Street 2:
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-2126
Practice Address - Country:US
Practice Address - Phone:424-800-1599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-14
Last Update Date:2012-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor