Individual
RAYMOND LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
14677 MERRILL AVE, FONTANA, CA 92335-4219
(951) 643-2340
Mailing address
8950 MAGNOLIA AVE UNIT 213, MONTCLAIR, CA 91763-1461
(909) 605-3303
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
42062
CA
Other
Enumeration date
08/02/2021
Last updated
08/02/2021
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