Provider Demographics
NPI:1982366746
Name:LOPEZ, GIOCONDA
Entity Type:Individual
Prefix:
First Name:GIOCONDA
Middle Name:
Last Name:LOPEZ
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 1:801 GATEWAY BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-7402
Mailing Address - Country:US
Mailing Address - Phone:650-616-2577
Mailing Address - Fax:
Practice Address - Street 1:801 GATEWAY BLVD STE 400
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-7402
Practice Address - Country:US
Practice Address - Phone:650-713-8326
Practice Address - Fax:833-522-0986
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-08
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty