Provider Demographics
NPI:1851932438
Name:LOPEZ, PRISCILLA (BA)
Entity Type:Individual
Prefix:MS
First Name:PRISCILLA
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2230 WILMA AVE
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:CA
Mailing Address - Zip Code:90040-3933
Mailing Address - Country:US
Mailing Address - Phone:323-359-1364
Mailing Address - Fax:
Practice Address - Street 1:1000 CORPORATE CENTER DR STE 120
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-7610
Practice Address - Country:US
Practice Address - Phone:855-345-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-04
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician