Provider Demographics
NPI:1164176129
Name:LOPEZ LOPEZ, MARIA ISABEL
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ISABEL
Last Name:LOPEZ LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 ANITA ST
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-4108
Mailing Address - Country:US
Mailing Address - Phone:619-709-7864
Mailing Address - Fax:
Practice Address - Street 1:325 ANITA ST
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-4108
Practice Address - Country:US
Practice Address - Phone:619-709-7864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD3674532103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst