Healthcare Provider Details

I. General information

NPI: 1801914304
Provider Name (Legal Business Name): ISELA LOPEZ LCSW83713
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 01/20/2025
Certification Date: 01/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21633 AVENUE 24
CHOWCHILLA CA
93610-9650
US

IV. Provider business mailing address

21633 AVENUE 24
CHOWCHILLA CA
93610-9650
US

V. Phone/Fax

Practice location:
  • Phone: 559-260-9811
  • Fax:
Mailing address:
  • Phone: 559-313-2383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW83713
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: