Healthcare Provider Details

I. General information

NPI: 1790288215
Provider Name (Legal Business Name): KATHERINE LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2018
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2271 ALPINE BLVD STE A
ALPINE CA
91901-1101
US

IV. Provider business mailing address

225 SIMI VILLAGE DR UNIT 940325
SIMI VALLEY CA
93065-7426
US

V. Phone/Fax

Practice location:
  • Phone: --
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT159593
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberF4399196
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: