1710020565 NPI number — MRS. JOANNE CORTES LOPEZ L.C.S.W.

Table of content: MRS. JOANNE CORTES LOPEZ L.C.S.W. (NPI 1710020565)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710020565 NPI number — MRS. JOANNE CORTES LOPEZ L.C.S.W.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOPEZ
Provider First Name:
JOANNE
Provider Middle Name:
CORTES
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
L.C.S.W.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GONZALES
Provider Other First Name:
JOANNE
Provider Other Middle Name:
CORTES
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1710020565
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/16/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7113 LYNDALE CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELK GROVE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95758-6357
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-427-7122
Provider Business Mailing Address Fax Number:
916-427-7122

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7245 E SOUTHGATE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95823-2620
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-427-7141
Provider Business Practice Location Address Fax Number:
916-427-7122
Provider Enumeration Date:
02/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  21930 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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