Individual
CAROLINA LOPEZ ROURA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1400 N NORMA ST, RIDGECREST, CA 93555-2575
(760) 499-7406
Mailing address
1400 N NORMA ST STE 133, RIDGECREST, CA 93555-2577
(760) 977-9084
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
175T00000X
Peer Specialist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
92645495D43358
MEDICAL
CA
Enumeration date
09/27/2019
Last updated
12/18/2019
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