Doctor Name: | GUSTAVO LOPEZ |
NPI Number: | 1194938480 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | |
Business Practice Address: | 10015 Palisades Dr Ste 1 Truckee, CA - 961611941 |
Business Phone Number: | 5305878194 |
Business Fax Number: | 5305875617 |
Mailing Address: | Po Box 1344, TRUCKEE |
State: | CA |
Postal Code: | 961601344 |
Phone Number: | 5305878194 |
Fax Number: | 5305875617 |
NPI Enumeration Date: | 05/07/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |