Provider Demographics
NPI:1205116621
Name:LOPEZ, JAIME
Entity type:Individual
Prefix:MR
First Name:JAIME
Middle Name:
Last Name:LOPEZ
Suffix:
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 1:10816 WHITWORTH RD
Mailing Address - Street 2:
Mailing Address - City:GUSTINE
Mailing Address - State:CA
Mailing Address - Zip Code:95322-9751
Mailing Address - Country:US
Mailing Address - Phone:209-247-9300
Mailing Address - Fax:
Practice Address - Street 1:1870 CORDELL CT
Practice Address - Street 2:SUITE 101
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-0914
Practice Address - Country:US
Practice Address - Phone:619-448-9700
Practice Address - Fax:619-448-9711
Is Sole Proprietor?:No
Enumeration Date:2011-08-17
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator