Healthcare Provider Details

I. General information

NPI: 1811851249
Provider Name (Legal Business Name): LETICIA LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2026 W BEACON AVE
ANAHEIM CA
92804-4406
US

IV. Provider business mailing address

2026 W BEACON AVE
ANAHEIM CA
92804-4406
US

V. Phone/Fax

Practice location:
  • Phone: 657-276-7030
  • Fax: 714-426-8160
Mailing address:
  • Phone: 657-276-7030
  • Fax: 714-426-8160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: