Provider Demographics
NPI:1568178358
Name:LOPEZ, JESSICA MELINA
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MELINA
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:MELINA
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11075 PINE AVE
Mailing Address - Street 2:
Mailing Address - City:LYNWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90262-2953
Mailing Address - Country:US
Mailing Address - Phone:424-200-2003
Mailing Address - Fax:
Practice Address - Street 1:1315 N BULLIS RD
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90221-1650
Practice Address - Country:US
Practice Address - Phone:562-506-7553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst