Provider Demographics
NPI:1386998862
Name:LOPEZ, NOEL SR (MA)
Entity type:Individual
Prefix:
First Name:NOEL
Middle Name:
Last Name:LOPEZ
Suffix:SR
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 125
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95353-0125
Mailing Address - Country:US
Mailing Address - Phone:209-505-3360
Mailing Address - Fax:
Practice Address - Street 1:1117 HUNTINGTON DR
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-3457
Practice Address - Country:US
Practice Address - Phone:209-505-3360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2472E0500XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherEEG