Provider Demographics
NPI:1306598297
Name:FREDERICK LOPEZ LLC
Entity type:Organization
Organization Name:FREDERICK LOPEZ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PSY32140
Authorized Official - Phone:909-251-2449
Mailing Address - Street 1:27162 GOLDEN FIELD CT
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555-4538
Mailing Address - Country:US
Mailing Address - Phone:909-251-2449
Mailing Address - Fax:909-494-4208
Practice Address - Street 1:1012 E COOLEY DR STE B2
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-3959
Practice Address - Country:US
Practice Address - Phone:951-567-1135
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-21
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty