Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003291790 |
---|---|
Provider Name | Enrique Lopez-Castro |
First Address | Oakland, CA 94601-2322 |
Second Address | Oakland, CA 94601-2322 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2015 |
Last Update Date | 23/07/2015 |