Provider Demographics
NPI:1770395618
Name:LOPEZ, CARLOS (ELECTROLYSIST)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:ELECTROLYSIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3032 TULARE ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93721-1415
Mailing Address - Country:US
Mailing Address - Phone:559-889-3246
Mailing Address - Fax:559-422-6151
Practice Address - Street 1:3032 TULARE ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93721-1415
Practice Address - Country:US
Practice Address - Phone:559-889-3246
Practice Address - Fax:559-422-6151
Is Sole Proprietor?:No
Enumeration Date:2025-01-27
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL9978247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other