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1023155694
JERRY WAYNE LOPEZ
RIALTO, CA
NPI
1023155694
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YM0800X Counselor, Mental Health
(Licence: CA 22964)
Enumeration Date
2007-01-31
Last Update Date
2007-07-08
Business Address
Mr. JERRY WAYNE LOPEZ PT
850 E FOOTHILL BLVD
RIALTO, CA 92376-5230
Phone number: 909-421-9370
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Mailing Address
Mr. JERRY WAYNE LOPEZ PT
8189 PALMETTO AVE APT 212
FONTANA, CA 92335-3692
Phone number: 909-561-6473
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