MEDICARE: MIYKAL CLARISSA LOPEZ

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	225700000X	Massage Therapist	22239	CA

General Provider Information

NPI Number	:	1790637734
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIYKAL CLARISSA LOPEZ

Provider Business Mailing Address
First Line	:	4506 SATURN ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90019-5847
Country	:	US
Telephone Number	:	323-815-6205
Fax Number	:

Provider Business Practice Location Address
First Line	:	955 CARRILLO DR STE 103
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-5400
Country	:	US
Telephone Number	:	323-815-6205
Fax Number	:

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

Provider Enumeration Date	:	02/12/2026
Last Update Date	:	02/12/2026

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Directions to “ MIYKAL CLARISSA LOPEZ ” Practice Location

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