Individual
MADAI LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
13169 SOLAR BAY LN, VICTORVILLE, CA 92394-9523
(760) 373-0471
Mailing address
13169 SOLAR BAY LN, VICTORVILLE, CA 92394-9523
(760) 373-0471
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
PT31731
CA
Other
Enumeration date
08/17/2010
Last updated
04/11/2014
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