Individual
MR. GUSTAVO LOPEZ JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
256 WASHINGTON ST, MOUNT VERNON, NY 10553-1052
(914) 613-0700
(914) 664-8189
Mailing address
330 CENTER AVE, MAMARONECK, NY 10543-2303
(914) 217-0981
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
NY
Other
Enumeration date
09/26/2017
Last updated
03/07/2025
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