Provider Demographics
NPI:1962039529
Name:LOPEZ, LUZ ELENA (MS)
Entity Type:Individual
Prefix:
First Name:LUZ
Middle Name:ELENA
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2615 PACIFIC COAST HWY
Mailing Address - Street 2:
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-2225
Mailing Address - Country:US
Mailing Address - Phone:310-406-1500
Mailing Address - Fax:
Practice Address - Street 1:2615 PACIFIC COAST HWY
Practice Address - Street 2:
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-2225
Practice Address - Country:US
Practice Address - Phone:310-406-1500
Practice Address - Fax:310-406-1531
Is Sole Proprietor?:No
Enumeration Date:2020-03-24
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-22-60991103K00000X
106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst