Provider Demographics
NPI:1912565557
Name:LOPOZ, AFRODESIA C
Entity Type:Individual
Prefix:
First Name:AFRODESIA
Middle Name:C
Last Name:LOPOZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1149 FAIR WEATHER CIR
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94518-1939
Mailing Address - Country:US
Mailing Address - Phone:925-483-1096
Mailing Address - Fax:925-955-9000
Practice Address - Street 1:1807 E LONG ST
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89706-3214
Practice Address - Country:US
Practice Address - Phone:775-883-4449
Practice Address - Fax:775-883-4403
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5713010310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility