Provider Demographics
NPI:1437944832
Name:DEWITT LOPEZ, BLANCA IRIS
Entity type:Individual
Prefix:
First Name:BLANCA
Middle Name:IRIS
Last Name:DEWITT 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 1:752 W 23RD ST
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-3610
Mailing Address - Country:US
Mailing Address - Phone:209-299-2042
Mailing Address - Fax:
Practice Address - Street 1:752 W 23RD ST
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-3610
Practice Address - Country:US
Practice Address - Phone:209-299-2042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management