Susana T Lara Lopez | Moreno Valley, CA • PECOS Search

Susana T Lara Lopez

Behavior Technician

Behavioral Health & Social Service Providers

24081 Sandy Glade Ave, Moreno Valley, CA 92557-5529

PECOS Enrollment

Based on the most recent information from CMS, provider Susana T Lara Lopez does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1205627502
Provider Type
Individual
Full Name
Lara Lopez, Susana T
Gender
Female

Sole Proprietor
No
Enumeration Date
5/15/2025
Last Updated
5/15/2025

Contact Information

Practice Location

24081 Sandy Glade Ave, Moreno Valley, CA 92557-5529

Unlisted Fax

Mailing Location

24081 Sandy Glade Ave, Moreno Valley, CA 92557-5529

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 106S00000X Primary	Description Behavior Technician Behavioral Health & Social Service Providers	License Unlisted Issuer