Provider Demographics
NPI:1245267020
Name:LOPEZ, EDITH MARGARITA (PHD)
Entity type:Individual
Prefix:DR
First Name:EDITH
Middle Name:MARGARITA
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 DECLARATION DR STE 7
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-4928
Mailing Address - Country:US
Mailing Address - Phone:530-899-0964
Mailing Address - Fax:
Practice Address - Street 1:75 DECLARATION DR
Practice Address - Street 2:SUITE #3
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-4914
Practice Address - Country:US
Practice Address - Phone:530-899-0964
Practice Address - Fax:530-899-0964
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17707103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PL177070Medicare ID - Type Unspecified