Individual
JUAN LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
148 S COLE RD, BOISE, ID 83709-0932
(208) 683-8320
Mailing address
148 S COLE RD, BOISE, ID 83709-0932
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
ID
175T00000X
Peer Specialist
—
ID
Other
Enumeration date
10/31/2025
Last updated
10/31/2025
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