Provider Demographics
NPI:1407535966
Name:LOPEZ, AIDA ALEJANDRA
Entity Type:Individual
Prefix:
First Name:AIDA
Middle Name:ALEJANDRA
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AIDA
Other - Middle Name:ALEJANDRA
Other - Last Name:SALAZAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 220833
Mailing Address - Street 2:
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91322-0833
Mailing Address - Country:US
Mailing Address - Phone:818-518-3785
Mailing Address - Fax:
Practice Address - Street 1:22621 LYONS AVE STE 201
Practice Address - Street 2:
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-1782
Practice Address - Country:US
Practice Address - Phone:818-606-3294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist