Provider Demographics
NPI:1568138022
Name:LOPEZ, CRISTAL JESENIA (BA, RBT)
Entity Type:Individual
Prefix:
First Name:CRISTAL
Middle Name:JESENIA
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:BA, RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 E VENTURA ST UNIT G
Mailing Address - Street 2:
Mailing Address - City:SANTA PAULA
Mailing Address - State:CA
Mailing Address - Zip Code:93060-3809
Mailing Address - Country:US
Mailing Address - Phone:805-451-2883
Mailing Address - Fax:
Practice Address - Street 1:126 E VENTURA ST UNIT G
Practice Address - Street 2:
Practice Address - City:SANTA PAULA
Practice Address - State:CA
Practice Address - Zip Code:93060-3809
Practice Address - Country:US
Practice Address - Phone:805-451-2883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician