Provider Demographics
NPI:1366007825
Name:LOPEZ, ANTOINEKA J
Entity Type:Individual
Prefix:
First Name:ANTOINEKA
Middle Name:J
Last Name: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 1:576 HARTNELL ST STE 300
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-2887
Mailing Address - Country:US
Mailing Address - Phone:831-625-4600
Mailing Address - Fax:831-625-4610
Practice Address - Street 1:576 HARTNELL ST STE 300
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-2887
Practice Address - Country:US
Practice Address - Phone:831-625-4600
Practice Address - Fax:831-625-4610
Is Sole Proprietor?:No
Enumeration Date:2019-05-09
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA90674104100000X
CA1171901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker