Provider Demographics
NPI:1770303687
Name:LOPEZ, JASON GALAVIZ
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:GALAVIZ
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 1:1128 W WALTER AVE UNIT 65
Mailing Address - Street 2:
Mailing Address - City:FOWLER
Mailing Address - State:CA
Mailing Address - Zip Code:93625-4420
Mailing Address - Country:US
Mailing Address - Phone:553-344-7540
Mailing Address - Fax:
Practice Address - Street 1:1533 7TH ST STE 302
Practice Address - Street 2:
Practice Address - City:SANGER
Practice Address - State:CA
Practice Address - Zip Code:93657-2494
Practice Address - Country:US
Practice Address - Phone:559-344-7540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA82004225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist