Provider Demographics
NPI:1356991459
Name:LOPEZ SOLANO, BRIANNA GRACIELA
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:GRACIELA
Last Name:LOPEZ SOLANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1146 KIMBALL AVE
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-2121
Mailing Address - Country:US
Mailing Address - Phone:510-925-7603
Mailing Address - Fax:
Practice Address - Street 1:1146 KIMBALL AVE
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-2121
Practice Address - Country:US
Practice Address - Phone:510-925-7603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-19
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician