Provider Demographics
NPI:1639859432
Name:LOPEZ-ORTIZ, MARIA GUADALUPE (QMHP INTERN)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:GUADALUPE
Last Name:LOPEZ-ORTIZ
Suffix:
Gender:F
Credentials:QMHP INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13970 SW 6TH ST
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-3717
Mailing Address - Country:US
Mailing Address - Phone:971-708-4759
Mailing Address - Fax:
Practice Address - Street 1:4537 SW 96TH AVE
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-3329
Practice Address - Country:US
Practice Address - Phone:503-376-9520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-18
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health