KAELAN VINCENT LOPEZ

PLACERVILLE, CA
NPI1811571680
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: CA  11812)
Enumeration Date2021-05-07
Last Update Date2021-05-07
Business Address
KAELAN VINCENT LOPEZ SUDRC
2844 COLOMA ST
PLACERVILLE, CA 95667-4406
Phone number: 530-642-1715
Mailing Address
KAELAN VINCENT LOPEZ SUDRC
PO BOX 1666
PLACERVILLE, CA 95667-1666
Phone number:
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