Provider Demographics
NPI:1326528704
Name:LOPEZ, SHELLI ANN
Entity Type:Individual
Prefix:
First Name:SHELLI
Middle Name:ANN
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHELLI
Other - Middle Name:ANN
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:324 E BIXBY RD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-3432
Mailing Address - Country:US
Mailing Address - Phone:562-595-8111
Mailing Address - Fax:
Practice Address - Street 1:324 E BIXBY RD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-3432
Practice Address - Country:US
Practice Address - Phone:562-595-8111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2023-08-16
Deactivation Date:2022-08-15
Deactivation Code:
Reactivation Date:2022-09-21
Provider Licenses
StateLicense IDTaxonomies
CA171M00000X, 172V00000X
175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No175T00000XOther Service ProvidersPeer Specialist