Provider Demographics
NPI:1205696093
Name:LOPEZ, EDITHA BERTHA (BCBA)
Entity type:Individual
Prefix:
First Name:EDITHA
Middle Name:BERTHA
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11324 AMIGO AVE
Mailing Address - Street 2:
Mailing Address - City:PORTER RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91326-2118
Mailing Address - Country:US
Mailing Address - Phone:818-388-6721
Mailing Address - Fax:
Practice Address - Street 1:11324 AMIGO AVE
Practice Address - Street 2:
Practice Address - City:PORTER RANCH
Practice Address - State:CA
Practice Address - Zip Code:91326-2118
Practice Address - Country:US
Practice Address - Phone:818-388-6721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst