Provider Demographics
NPI:1174196877
Name:LOPEZ, DAISY GUADALUPE
Entity Type:Individual
Prefix:MRS
First Name:DAISY
Middle Name:GUADALUPE
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DAISY
Other - Middle Name:GUADALUPE
Other - Last Name:RANGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1142 W BUXTON ST
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92377-8833
Mailing Address - Country:US
Mailing Address - Phone:909-419-0967
Mailing Address - Fax:
Practice Address - Street 1:1142 W BUXTON ST
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92377-8833
Practice Address - Country:US
Practice Address - Phone:909-419-0967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician