Active NPI
Marcos Damian Lopez, PH.D.
- Clinical Psychologist
- Elk Grove, CA
National Provider Identifier
1336468925
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY-25939
- Practice address
- 9403 Aizenberg Cir
Elk Grove, CA 95624-1662 - Phone
- (916) 702-8750
- Fax
- (916) 720-0590
- NPI assigned
- May 22, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cognitive & Behavioral Psychologist | 103TB0200X | PSY-25939 | CA | |
| Clinical Psychologist | 103TC0700X | PSY-25939 | CA | Primary |
Addresses
Primary practice location
9403 Aizenberg Cir
Elk Grove, CA 95624-1662
Mailing address
8850 Williamson Dr Unit 2079
Elk Grove, CA 95759-4063
Phone (916) 702-8750
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20201229002341 | CA | Practitioner - Clinical Psychologist | 4082027560 | Practice locations: Elk Grove, CA |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 2011
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
8855 Minnie Cir
Elk Grove, CA 95624-2248
Phone (916) 702-8750
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY-25939 | CA | MD | Cognitive & Behavioral Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1274486400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1723161600000",
"number": "1336468925",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8850 WILLIAMSON DR UNIT 2079",
"city": "ELK GROVE",
"state": "CA",
"postal_code": "957594063",
"telephone_number": "916-702-8750",
"fax_number": "916-720-0590"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9403 AIZENBERG CIR",
"city": "ELK GROVE",
"state": "CA",
"postal_code": "956241662",
"telephone_number": "916-702-8750",
"fax_number": "916-720-0590"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LOPEZ",
"first_name": "MARCOS",
"middle_name": "DAMIAN",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-05-22",
"last_updated": "2024-08-09",
"certification_date": "2024-08-09",
"status": "A"
},
"taxonomies": [
{
"code": "103TB0200X",
"taxonomy_group": "",
"desc": "Psychologist, Cognitive & Behavioral",
"state": "CA",
"license": "PSY-25939",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY-25939",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Elk Grove, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.