Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225C00000X | Rehabilitation Counselor |
NPI | 1164773651 |
---|---|
Provider Name | Maria Suzanna Lopez |
First Address | San Diego, CA 92108 |
Second Address | San Diego, CA 92108-3505 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2012 |
Last Update Date | 04/10/2021 |