Provider Demographics
NPI:1447881198
Name:LOPEZ, ARNOLD JORGE
Entity type:Individual
Prefix:
First Name:ARNOLD
Middle Name:JORGE
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 1:577 DANIEL ST
Mailing Address - Street 2:
Mailing Address - City:CENTRAL POINT
Mailing Address - State:OR
Mailing Address - Zip Code:97502-3905
Mailing Address - Country:US
Mailing Address - Phone:541-778-5208
Mailing Address - Fax:
Practice Address - Street 1:3709 CITATION WAY STE 102
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-9022
Practice Address - Country:US
Practice Address - Phone:541-500-6532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-31
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician