Provider Demographics
NPI:1477187458
Name:LOPEZ MOLNAR, AMBER L
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:L
Last Name:LOPEZ MOLNAR
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 1:20527 OSAGE AVE
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-3615
Mailing Address - Country:US
Mailing Address - Phone:310-780-5469
Mailing Address - Fax:
Practice Address - Street 1:1801 S CATALINA AVE STE 306
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-5513
Practice Address - Country:US
Practice Address - Phone:310-780-5469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-27
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT92867106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist