Provider Demographics
NPI:1013704329
Name:LOPEZ, JUAN CARLOS (PSYD STUDENT)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:CARLOS
Last Name:LOPEZ
Suffix:
Gender:
Credentials:PSYD STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2363 CRAIG CT
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94043-2725
Mailing Address - Country:US
Mailing Address - Phone:510-418-3016
Mailing Address - Fax:
Practice Address - Street 1:1070 CONCORD AVE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-5699
Practice Address - Country:US
Practice Address - Phone:925-849-4695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program