Provider Demographics
NPI:1780811992
Name:LOPEZ, CRISTOBAL JORGE (LMFT 86806)
Entity type:Individual
Prefix:
First Name:CRISTOBAL
Middle Name:JORGE
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:LMFT 86806
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 SAND CREEK RD STE 202K
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-2220
Mailing Address - Country:US
Mailing Address - Phone:925-876-8525
Mailing Address - Fax:
Practice Address - Street 1:191 SAND CREEK RD STE 202K
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-2220
Practice Address - Country:US
Practice Address - Phone:925-876-8525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-15
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA86806106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health