Individual
SERGIO LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
R-AAC, CPSST
Contact information
Practice address
1340 12TH AVE, LONGVIEW, WA 98632-3820
(360) 998-2047
(844) 612-6673
Mailing address
PO BOX 2394, LONGVIEW, WA 98632-8455
(360) 200-5419
(844) 612-6673
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
CG70062661
WA
175T00000X
Peer Specialist
Primary
PE70066491
WA
Other
Enumeration date
11/10/2025
Last updated
11/10/2025
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