Provider Demographics
NPI:1992842470
Name:LOPEZ, SAMUEL D (SUBSTANCE ABUSE COUN)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:D
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:SUBSTANCE ABUSE COUN
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:83912 AVENUE 45 STE 9
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-3338
Mailing Address - Country:US
Mailing Address - Phone:760-347-0754
Mailing Address - Fax:760-347-8507
Practice Address - Street 1:83912 AVENUE 45
Practice Address - Street 2:SUITE 9
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-3338
Practice Address - Country:US
Practice Address - Phone:760-347-0754
Practice Address - Fax:760-347-8507
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)