Provider Demographics
NPI:1700081015
Name:LOPEZ, ROSLYN ORTEIZA (MS)
Entity Type:Individual
Prefix:MRS
First Name:ROSLYN
Middle Name:ORTEIZA
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MRS
Other - First Name:ROSLYN
Other - Middle Name:DANIELLE
Other - Last Name:ORTEIZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:150 MUIR RD
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-4668
Mailing Address - Country:US
Mailing Address - Phone:360-701-3221
Mailing Address - Fax:
Practice Address - Street 1:150 MUIR RD
Practice Address - Street 2:AB5
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-4668
Practice Address - Country:US
Practice Address - Phone:925-852-9286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor