Provider Demographics
NPI:1982589982
Name:JOHANSON LOPEZ, MARIO EDUARDO
Entity type:Individual
Prefix:
First Name:MARIO
Middle Name:EDUARDO
Last Name:JOHANSON 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 1:9701 FIELDS RD APT 600
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-2729
Mailing Address - Country:US
Mailing Address - Phone:240-608-0938
Mailing Address - Fax:
Practice Address - Street 1:4455 CONNECTICUT AVE NW APT 101
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-2300
Practice Address - Country:US
Practice Address - Phone:240-608-0938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-08
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant