Provider Demographics
NPI:1689986051
Name:LOPEZ, CESAR
Entity Type:Individual
Prefix:
First Name:CESAR
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4505 RAMONA AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750-3276
Mailing Address - Country:US
Mailing Address - Phone:323-481-0158
Mailing Address - Fax:
Practice Address - Street 1:4505 RAMONA AVE APT 1
Practice Address - Street 2:
Practice Address - City:LA VERNE
Practice Address - State:CA
Practice Address - Zip Code:91750-3276
Practice Address - Country:US
Practice Address - Phone:323-481-0158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health