Individual
RAYMOND BENJAMIN LOPEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CNA
Contact information
Practice address
750 N FREEDOM BLVD, PROVO, UT 84601-1677
(801) 373-7394
Mailing address
750 N FREEDOM BLVD, PROVO, UT 84601-1677
(801) 373-4760
(801) 373-0639
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
171M00000X
UT
Other
Enumeration date
07/13/2020
Last updated
07/13/2020
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