Provider Demographics
NPI:1447867270
Name:LOPEZ, JULIO CESAR
Entity type:Individual
Prefix:
First Name:JULIO
Middle Name:CESAR
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13515 SE 208TH ST
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98042-3024
Mailing Address - Country:US
Mailing Address - Phone:509-398-6883
Mailing Address - Fax:
Practice Address - Street 1:13515 SE 208TH ST
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98042-3024
Practice Address - Country:US
Practice Address - Phone:509-398-6883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-25
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC9489171R00000X
WASC7722171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter