MEDICARE: MS. LIZETH GABRIELA LOPEZ PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	77139	CA
2	103TC0700X	Clinical Psychologist	33663	CA

General Provider Information

NPI Number	:	1225296965
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LIZETH GABRIELA LOPEZ PSYD

Provider Business Mailing Address
First Line	:	22837 VENTURA BLVD STE 200
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91364-1268
Country	:	US
Telephone Number	:	310-855-3276
Fax Number	:

Provider Business Practice Location Address
First Line	:	22837 VENTURA BLVD STE 200
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91364-1268
Country	:	US
Telephone Number	:	310-855-3276
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2008
Last Update Date	:	10/03/2022

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