Provider Demographics
NPI:1922845247
Name:LOPEZ, MARCELO JR
Entity type:Individual
Prefix:
First Name:MARCELO
Middle Name:
Last Name:LOPEZ
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4429 N TAMERA AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-4146
Mailing Address - Country:US
Mailing Address - Phone:559-394-7876
Mailing Address - Fax:
Practice Address - Street 1:49063 ROAD 426
Practice Address - Street 2:
Practice Address - City:OAKHURST
Practice Address - State:CA
Practice Address - Zip Code:93644-9487
Practice Address - Country:US
Practice Address - Phone:559-580-6902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-12
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)