Provider Demographics
NPI:1538728050
Name:LOPEZ, DAVID JR
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:LOPEZ
Suffix:JR
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 1:11381 DUNCAN CT
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-1418
Mailing Address - Country:US
Mailing Address - Phone:707-484-0274
Mailing Address - Fax:
Practice Address - Street 1:1725 AVOCADO RD
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-6103
Practice Address - Country:US
Practice Address - Phone:707-484-0274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-08
Last Update Date:2019-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician