Provider Demographics
NPI:1912585985
Name:LOPEZ, VALERIE R (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:VALERIE
Middle Name:R
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27599 CORAL ST
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92585-3706
Mailing Address - Country:US
Mailing Address - Phone:803-451-1895
Mailing Address - Fax:
Practice Address - Street 1:45 W 45TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-4602
Practice Address - Country:US
Practice Address - Phone:877-438-9335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-31
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA77569225700000X
CAD3815468225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA77569Medicaid
CAD3815468Medicaid