Provider Demographics
NPI:1639949985
Name:LOPEZ, KIMBERLY LOPEZ
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:LOPEZ
Last Name:LOPEZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2265 OAK HILLS CIR APT 153
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:94565-4222
Mailing Address - Country:US
Mailing Address - Phone:925-822-5458
Mailing Address - Fax:
Practice Address - Street 1:2425 BISSO LN STE 100
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-4817
Practice Address - Country:US
Practice Address - Phone:925-521-5630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-08
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X
CAMPSS-FGUHML175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No172V00000XOther Service ProvidersCommunity Health Worker