Provider Demographics
NPI:1356947451
Name:LOPEZ, JAVIER JR (CMT)
Entity type:Individual
Prefix:
First Name:JAVIER
Middle Name:
Last Name:LOPEZ
Suffix:JR
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1890 OREGANO WAY
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-6727
Mailing Address - Country:US
Mailing Address - Phone:415-574-0711
Mailing Address - Fax:
Practice Address - Street 1:1231 40TH ST APT 231
Practice Address - Street 2:
Practice Address - City:EMERYVILLE
Practice Address - State:CA
Practice Address - Zip Code:94608-3671
Practice Address - Country:US
Practice Address - Phone:415-691-9431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-05
Last Update Date:2020-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1268225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist