Healthcare Provider Details

I. General information

NPI: 1851986186
Provider Name (Legal Business Name): CELINA ELAINE LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2021
Last Update Date: 03/08/2021
Certification Date: 03/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10603 DOWNEY AVE
DOWNEY CA
90241-3426
US

IV. Provider business mailing address

12319 RAMSEY DR
WHITTIER CA
90605-4260
US

V. Phone/Fax

Practice location:
  • Phone: 562-622-2268
  • Fax:
Mailing address:
  • Phone: 562-475-6184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number14537-RAC
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: