Provider Demographics
NPI:1487326880
Name:LOPEZ-HUERTA, GIOVANNI SR (AMFT)
Entity type:Individual
Prefix:MR
First Name:GIOVANNI
Middle Name:
Last Name:LOPEZ-HUERTA
Suffix:SR
Gender:M
Credentials:AMFT
Other - Prefix:MR
Other - First Name:GIOVANNI
Other - Middle Name:
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AMFT
Mailing Address - Street 1:17053 FOOTHILL BLVD BLDG 2
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-3574
Mailing Address - Country:US
Mailing Address - Phone:909-347-1356
Mailing Address - Fax:
Practice Address - Street 1:17053 FOOTHILL BLVD BLDG 2
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-3574
Practice Address - Country:US
Practice Address - Phone:909-347-1356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-04
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA306406106H00000X
CA127380106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist