Provider Demographics
NPI:1790143121
Name:LOPEZ OSEGUERA, IGNACIO
Entity Type:Individual
Prefix:
First Name:IGNACIO
Middle Name:
Last Name:LOPEZ OSEGUERA
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 1:730 N EASTERN AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89101-2885
Mailing Address - Country:US
Mailing Address - Phone:702-994-3635
Mailing Address - Fax:702-664-0648
Practice Address - Street 1:730 N EASTERN AVE STE 110
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101-2885
Practice Address - Country:US
Practice Address - Phone:702-994-3635
Practice Address - Fax:702-664-0648
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-30
Last Update Date:2016-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health