Provider Demographics
NPI:1730597139
Name:LOPEZ, CLAUDIA
Entity type:Individual
Prefix:
First Name:CLAUDIA
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 1:2925 MCMILLAN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-6765
Mailing Address - Country:US
Mailing Address - Phone:805-540-1769
Mailing Address - Fax:
Practice Address - Street 1:1885 LUNDY AVE
Practice Address - Street 2:SUITE 223
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95131-1887
Practice Address - Country:US
Practice Address - Phone:408-503-7960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-29
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA913331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health