Provider Demographics
NPI:1306691118
Name:LOPEZ, REGINA HORTENCIA
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:HORTENCIA
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 N 14TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-6207
Mailing Address - Country:US
Mailing Address - Phone:408-785-9400
Mailing Address - Fax:669-609-6000
Practice Address - Street 1:65 N 14TH ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-6207
Practice Address - Country:US
Practice Address - Phone:498-809-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator