Provider Demographics
NPI:1811020159
Name:LOPEZ, ANITA E (CAADE REGISTRATION)
Entity Type:Individual
Prefix:MS
First Name:ANITA
Middle Name:E
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:CAADE REGISTRATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9040 DATE ST
Mailing Address - Street 2:APT L
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-2326
Mailing Address - Country:US
Mailing Address - Phone:909-561-1865
Mailing Address - Fax:
Practice Address - Street 1:7993 SIERRA AVE
Practice Address - Street 2:SUITE K
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-3330
Practice Address - Country:US
Practice Address - Phone:909-822-8720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPENDING101YA0400X
CACAADE PENDING101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)