Provider Demographics
NPI:1922130533
Name:LOPEZ, PORFIRIO HERNANDEZ (HEALTH WORKER)
Entity type:Individual
Prefix:
First Name:PORFIRIO
Middle Name:HERNANDEZ
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:HEALTH WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 TRUXTUN AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-3137
Mailing Address - Country:US
Mailing Address - Phone:661-868-8300
Mailing Address - Fax:
Practice Address - Street 1:3300 TRUXTUN AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-3137
Practice Address - Country:US
Practice Address - Phone:661-868-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 55732106H00000X
172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist