Provider Demographics
NPI:1992855415
Name:LOPEZ, ROSA E
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:E
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ROSA
Other - Middle Name:E
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MHW II
Mailing Address - Street 1:2315 VILLAGE CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:ATWATER
Mailing Address - State:CA
Mailing Address - Zip Code:95301-2819
Mailing Address - Country:US
Mailing Address - Phone:209-358-3922
Mailing Address - Fax:
Practice Address - Street 1:480 E 13TH ST
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-6214
Practice Address - Country:US
Practice Address - Phone:209-381-6880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator