Provider Demographics
NPI:1013672625
Name:JUAN, JOSEPH LOPEZ III
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:LOPEZ
Last Name:JUAN
Suffix:III
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 1:1200 CONCORD AVE STE 450
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-4959
Mailing Address - Country:US
Mailing Address - Phone:925-933-2627
Mailing Address - Fax:
Practice Address - Street 1:1200 CONCORD AVE STE 450
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-4959
Practice Address - Country:US
Practice Address - Phone:925-933-2627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-08
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health