Provider Demographics
NPI:1689130155
Name:MICHELLE LOPEZ PHD PSYCHOLOGY INC
Entity Type:Organization
Organization Name:MICHELLE LOPEZ PHD PSYCHOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:619-800-1566
Mailing Address - Street 1:16959 BERNARDO CENTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-2555
Mailing Address - Country:US
Mailing Address - Phone:619-800-1566
Mailing Address - Fax:
Practice Address - Street 1:16959 BERNARDO CENTER DR STE 200
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2555
Practice Address - Country:US
Practice Address - Phone:619-800-1566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-20
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)