Provider Demographics
NPI:1932645116
Name:LOPEZ CAMPOS, NELSON JR (MA, TEACHING CRED)
Entity Type:Individual
Prefix:MR
First Name:NELSON
Middle Name:
Last Name:LOPEZ CAMPOS
Suffix:JR
Gender:M
Credentials:MA, TEACHING CRED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2196 KENDALL DR APT 226
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92407-4646
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10187 TRADEPOST RD
Practice Address - Street 2:
Practice Address - City:LUCERNE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92356-8537
Practice Address - Country:US
Practice Address - Phone:760-490-3581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-12
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician