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MIGUEL EZEQUIEL LOPEZ
NPI 1104413640
Marriage & Family Therapist in Modesto, CA

Active since December 30, 2020PECOS Enrolled
PO BOX 577924, MODESTO, CA 95357(094) 123-4252 Get Directions Write a Review

NPPES record last updated: June 26, 2025. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Jun 26, 2025, Feb 13, 2023, Sep 21, 2022 and 1 more (4 updates tracked since 2020).

About Miguel Ezequiel Lopez NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MIGUEL EZEQUIEL LOPEZ (NPI 1104413640) is an individual marriage & family therapist in Modesto, California, licensed in California (155022) and active in the NPI registry since December 2020. He is enrolled in Medicare PECOS and is a graduate of Other (2020).

NPPES Registry Identity

NPI1104413640
Entity TypeIndividualMale
Primary Taxonomy106H00000X
Provider Legal NameMIGUEL EZEQUIEL LOPEZ
Location AddressPO BOX 577924Modesto, CA 95357-7924
Mailing AddressPo Box 577924Modesto, CA 95357-7924 · (094) 123-4252
Phone(094) 123-4252
Sole ProprietorYes
Medical School CMSOtherGraduated 2020
Enumeration DateDecember 30, 2020
Last NPPES UpdateJune 26, 20254 updates tracked since enumeration
NPPES CertifiedJune 26, 2025
✔ NPI 1104413640 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyMarriage & Family TherapistBehavioral Health & Social Service Providers
Taxonomy Code106H00000X
License✔ Licensed in CA · 155022
Definition
A marriage and family therapist is a person with a master's degree in marriage and family therapy, or a master's or doctoral degree in a related mental health field with substantially equivalent coursework in marriage and family therapy, who receives supervised clinical experience, or a person who meets the state requirements to practice as a marriage and family therapist. A marriage and family therapist treats mental and emotional disorders within the context of marriage and family systems. A marriage and family therapist provides mental health and counseling services to individuals, couples, families, and groups.
PO BOX 577924, Modesto, CA 95357
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Miguel Ezequiel Lopez is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID143725887
PECOS Enrollment IDI20250924002896
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

2

Medicare enrollment records show Miguel Lopez reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Grow Healthcare Group PC
54 mi
Mental Health
99 S ALMADEN BLVD STE 600
San Jose, CA 95113
  • Reassigned Medicare billing, California enrollment
  • 3,139 clinicians in this Medicare group
NPI 1154994846 (408) 402-4385
Sud Specialty Group - Ca
56 mi
Addiction Medicine
4633 OLD IRONSIDES DR STE 304
Santa Clara, CA 95054
  • Reassigned Medicare billing, California enrollment
  • 1,607 clinicians in this Medicare group
NPI 1972138238 (323) 205-7088

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Miguel Lopez's NPI number?

The NPI number for Miguel Lopez is 1104413640. It was assigned to this individual provider in the NPPES registry on December 30, 2020.

Where is Miguel Lopez located?

Miguel Lopez practices at PO Box 577924, Modesto, CA 95357. The listed phone number is (094) 123-4252.

What is Miguel Lopez's specialty?

The primary specialty registered for this NPI is Marriage & Family Therapist with taxonomy code 106H00000X.

Is Miguel Lopez enrolled in Medicare?

Yes. Miguel Lopez is registered in the Medicare PECOS enrollment system.

Which organizations bill Medicare for Miguel Lopez's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Miguel Lopez reassigns Medicare benefits to 2 organizations: Grow Healthcare Group PC (San Jose, CA) and Sud Specialty Group - Ca (Santa Clara, CA). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Miguel Lopez's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Miguel Lopez was last updated on June 26, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.