Individual ProviderMiguel Angel LopezBehavior TechnicianBehavioral Health & Social Service ProvidersPractice Address12125 Day St, Moreno Valley, CA 92557-6702(951) 344-2166PECOS EnrollmentBased on the most recent information from CMS, provider Miguel Angel Lopez does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1255162137Provider TypeIndividualFull NameLopez, Miguel AngelGenderMaleSole ProprietorNoEnumeration Date8/12/2024Last Updated8/12/2024Contact InformationPractice LocationPractice Address12125 Day St, Moreno Valley, CA 92557-6702Phone(951) 344-2166FaxUnlisted FaxMailing LocationMailing Address996 Royal Marco Way, Marco Island, FL 34145-1829PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode106S00000XPrimaryDescriptionBehavior TechnicianBehavioral Health & Social Service ProvidersLicenseY1676366California