MEDICARE: PATRICIA LOPEZ WHITE LMFT

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	27930	CA

General Provider Information

NPI Number	:	1851813737
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA LOPEZ WHITE LMFT

Provider Business Mailing Address
First Line	:	421 BERNARD ST APT 416
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92627-5788
Country	:	US
Telephone Number	:	949-202-6610
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 LAKE ST UNIT 209
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92648-5815
Country	:	US
Telephone Number	:	949-202-6610
Fax Number	:

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

Provider Enumeration Date	:	07/12/2017
Last Update Date	:	01/30/2023

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