Provider Demographics
NPI:1023519303
Name:LOPEZ, ARMANDO
Entity type:Individual
Prefix:
First Name:ARMANDO
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3041 SARIYA WAY
Mailing Address - Street 2:
Mailing Address - City:CERES
Mailing Address - State:CA
Mailing Address - Zip Code:95307-9202
Mailing Address - Country:US
Mailing Address - Phone:209-416-8651
Mailing Address - Fax:
Practice Address - Street 1:1581 CUMMINS DR STE B
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95358-6402
Practice Address - Country:US
Practice Address - Phone:209-492-5113
Practice Address - Fax:209-574-1541
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-22
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3D26ECD19F171400000X
CA1-19-36295103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No171400000XOther Service ProvidersHealth & Wellness Coach