Provider Demographics
NPI:1093084576
Name:LOPEZ, LETICIA GUILLEN (MSW)
Entity Type:Individual
Prefix:MRS
First Name:LETICIA
Middle Name:GUILLEN
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1827 ATLANTA AVE STE D3
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-7418
Mailing Address - Country:US
Mailing Address - Phone:951-955-8000
Mailing Address - Fax:
Practice Address - Street 1:1827 ATLANTA AVE STE D3
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-7418
Practice Address - Country:US
Practice Address - Phone:951-955-8000
Practice Address - Fax:951-955-8010
Is Sole Proprietor?:No
Enumeration Date:2011-12-29
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25207104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker