| Doctor Name: | MR. BENJAMIN JORDAN LOPEZ-GALVAN |
| NPI Number: | 1083003792 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | RN |
| License Number: | 95037759 |
| Business Practice Address: | 1860 Walnut St Ste A Red Bluff, CA - 960803611 |
| Business Phone Number: | 5305283204 |
| Business Fax Number: | 5305270240 |
| Mailing Address: | Po Box 400, RED BLUFF |
| State: | CA |
| Postal Code: | 960800400 |
| Phone Number: | 5305283204 |
| Fax Number: | 5305270240 |
| NPI Enumeration Date: | 01/19/2015 |
| NPI Last Update Date: | 01/19/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WP0809X |
| License Number: | 95037759 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Psych/Mental Health, Adult |
| Taxonomy Definition: | |