Healthcare Provider Details

I. General information

NPI: 1013674415
Provider Name (Legal Business Name): HADEY LOPEZ AVALOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2021
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 POMONA RD STE 233
CORONA CA
92878-4324
US

IV. Provider business mailing address

2550 N HOLLYWOOD WAY STE 102
BURBANK CA
91505-5031
US

V. Phone/Fax

Practice location:
  • Phone: 714-926-7708
  • Fax: 951-398-4393
Mailing address:
  • Phone: 866-727-8274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberY5967014
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: