Provider Demographics
NPI:1508025453
Name:LOPEZ, ISIS BERENICE
Entity Type:Individual
Prefix:
First Name:ISIS
Middle Name:BERENICE
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 1:3833 CUDAHY ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-6844
Mailing Address - Country:US
Mailing Address - Phone:323-637-0791
Mailing Address - Fax:
Practice Address - Street 1:2931 REDONDO AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-2445
Practice Address - Country:US
Practice Address - Phone:562-490-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner