Provider Demographics
NPI:1295560308
Name:PLATAS LOPEZ, JAQUELINE (MSW, PPSC)
Entity type:Individual
Prefix:
First Name:JAQUELINE
Middle Name:
Last Name:PLATAS LOPEZ
Suffix:
Gender:F
Credentials:MSW, PPSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 351042
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-9442
Mailing Address - Country:US
Mailing Address - Phone:310-621-7398
Mailing Address - Fax:
Practice Address - Street 1:1045 W REDONDO BEACH BLVD STE 300
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-4175
Practice Address - Country:US
Practice Address - Phone:323-241-6730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-06
Last Update Date:2024-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW1241061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical