Provider Demographics
NPI:1871274860
Name:GARCIA LOPEZ, MARIANA LISETTE
Entity type:Individual
Prefix:
First Name:MARIANA
Middle Name:LISETTE
Last Name:GARCIA LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2435 PYRAMID WAY STE B
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-1865
Mailing Address - Country:US
Mailing Address - Phone:775-657-8309
Mailing Address - Fax:
Practice Address - Street 1:850 MILL ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1413
Practice Address - Country:US
Practice Address - Phone:775-538-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-31
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician