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1811571680
KAELAN VINCENT LOPEZ
PLACERVILLE, CA
NPI
1811571680
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: CA 11812)
Enumeration Date
2021-05-07
Last Update Date
2021-05-07
Business Address
KAELAN VINCENT LOPEZ SUDRC
2844 COLOMA ST
PLACERVILLE, CA 95667-4406
Phone number: 530-642-1715
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Mailing Address
KAELAN VINCENT LOPEZ SUDRC
PO BOX 1666
PLACERVILLE, CA 95667-1666
Phone number:
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