Provider Demographics
NPI:1689717381
Name:LOPERENA, ANDREA M (MFC)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:M
Last Name:LOPERENA
Suffix:
Gender:F
Credentials:MFC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1855 N. FAIR OAKS AVE.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91103
Mailing Address - Country:US
Mailing Address - Phone:626-296-9971
Mailing Address - Fax:626-296-7714
Practice Address - Street 1:1855 N FAIR OAKS AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91103-1620
Practice Address - Country:US
Practice Address - Phone:626-296-7710
Practice Address - Fax:626-296-7714
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49042106H00000X
CAIMF42218225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner