Provider Demographics
NPI:1780558577
Name:LOPEZ, SAMANTHA MARIE
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:MARIE
Last Name:LOPEZ
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:SAMUELE
Other - Middle Name:MICHELANGELO
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5913 CORRIN WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-1618
Mailing Address - Country:US
Mailing Address - Phone:916-667-6314
Mailing Address - Fax:
Practice Address - Street 1:1651 RESPONSE RD STE 200
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-5255
Practice Address - Country:US
Practice Address - Phone:916-974-2599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-03
Last Update Date:2025-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty