Provider Demographics
NPI:1689452591
Name:LOPEZ PSYCHIATRIC SERVICES LLC
Entity Type:Organization
Organization Name:LOPEZ PSYCHIATRIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:HELEN
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:323-410-0021
Mailing Address - Street 1:50 W LEMON AVE STE 31
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-6152
Mailing Address - Country:US
Mailing Address - Phone:323-410-0021
Mailing Address - Fax:
Practice Address - Street 1:50 W LEMON AVE STE 31
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-6152
Practice Address - Country:US
Practice Address - Phone:323-410-0021
Practice Address - Fax:323-410-2001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-20
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty