Active NPI
Kaelan Vincent Lopez, SUDRC
- Addiction (Substance Use Disorder) Counselor
- Placerville, CA
National Provider Identifier
1811571680
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 11812
- Practice address
- 2844 Coloma St
Placerville, CA 95667-4406 - Phone
- (530) 642-1715
- NPI assigned
- May 7, 2021
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 11812 | CA | Primary |
Addresses
Primary practice location
2844 Coloma St
Placerville, CA 95667-4406
Mailing address
PO Box 1666
Placerville, CA 95667-1666
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11812 | CA | MD | Acupuncturist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1620345600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1620345600000",
"number": "1811571680",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1666",
"city": "PLACERVILLE",
"state": "CA",
"postal_code": "956671666"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2844 COLOMA ST",
"city": "PLACERVILLE",
"state": "CA",
"postal_code": "956674406",
"telephone_number": "530-642-1715"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LOPEZ",
"first_name": "KAELAN",
"middle_name": "VINCENT",
"credential": "SUDRC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-05-07",
"last_updated": "2021-05-07",
"certification_date": "2021-05-07",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "CA",
"license": "11812",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Placerville, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.