Provider Information for 1902296270
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Mrs. MICHELLE RENEE MAGEE-LOPEZ LMFT
Sex: Female
NPI: 1902296270
Last Updated: 2019-11-07
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1902296270 | ||||||||
| Enumeration Date | 2015-01-26 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | P.O.BOX 592 340 EAST 1ST STREET TUSTIN, CA 92781-9998 United States Phone: 323-767-4946 | Fax: | ||||||||
| Primary Practice Address | 17326 EDWARDS RD # A135 CERRITOS, CA 90703 United States Phone: 562-222-5258 | Fax: | ||||||||
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