Provider Demographics
NPI:1871674671
Name:LOPEZ, MICHELLE LORRAINE
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:LORRAINE
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1609 WOOD LK
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-6990
Mailing Address - Country:US
Mailing Address - Phone:714-834-7863
Mailing Address - Fax:714-834-8235
Practice Address - Street 1:1609 WOOD LK
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-6990
Practice Address - Country:US
Practice Address - Phone:714-834-7863
Practice Address - Fax:714-834-8235
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)