Provider Demographics
NPI:1881254928
Name:LOPEZ, ANNETTE CARRISOZA
Entity type:Individual
Prefix:MISS
First Name:ANNETTE
Middle Name:CARRISOZA
Last Name:LOPEZ
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 1:2613 SEXTANT AVE
Mailing Address - Street 2:
Mailing Address - City:PORT HUENEME
Mailing Address - State:CA
Mailing Address - Zip Code:93041-1415
Mailing Address - Country:US
Mailing Address - Phone:805-758-3620
Mailing Address - Fax:
Practice Address - Street 1:4258 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3706
Practice Address - Country:US
Practice Address - Phone:805-477-5700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-20
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician