Provider Demographics
NPI:1598415291
Name:LOPEZ, KAYLA JAYNIE
Entity Type:Individual
Prefix:MISS
First Name:KAYLA
Middle Name:JAYNIE
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 1:2221 CURTIS AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-2041
Mailing Address - Country:US
Mailing Address - Phone:310-703-9595
Mailing Address - Fax:
Practice Address - Street 1:2127 W ORANGEWOOD AVE STE B
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-1978
Practice Address - Country:US
Practice Address - Phone:818-960-6030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-25
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician