| Frederick Lopez Llc | |
|
1012 E Cooley Dr Ste B2 Colton CA 92324-3959 | |
| (951) 567-1135 | |
| Not Available |
| Full Name | Frederick Lopez Llc |
|---|---|
| Speciality | Psychologist |
| Location | 1012 E Cooley Dr Ste B2, Colton, California |
| Authorized Official Name and Position | Frederick Lopez (PSYCHOLOGIST) |
| Authorized Official Contact | 9092512449 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Frederick Lopez Llc 27162 Golden Field Ct Moreno Valley CA 92555-4538 Ph: (909) 251-2449 | Frederick Lopez Llc 1012 E Cooley Dr Ste B2 Colton CA 92324-3959 Ph: (951) 567-1135 |
| NPI Number | 1306598297 |
|---|---|
| Provider Enumeration Date | 01/21/2022 |
| Last Update Date | 03/04/2024 |
| Certification Date | 03/04/2024 |
| Medicare PECOS PAC ID | 2567857774 |
|---|---|
| Medicare Enrollment ID | O20220324000955 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306598297 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
| Provider Name | Frederick Lopez |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1669671699 PECOS PAC ID: 5991116436 Enrollment ID: I20201204001027 |
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