Provider Demographics
NPI:1871376699
Name:LOPEZ, FRANKIE RAE
Entity type:Individual
Prefix:
First Name:FRANKIE
Middle Name:RAE
Last Name: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 1:5537 TRIPP WAY
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-4971
Mailing Address - Country:US
Mailing Address - Phone:916-521-5363
Mailing Address - Fax:
Practice Address - Street 1:5537 TRIPP WAY
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-4971
Practice Address - Country:US
Practice Address - Phone:916-521-5363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-15
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMPSS-TWAYRJ175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist