Healthcare Provider Details

I. General information

NPI: 1265109037
Provider Name (Legal Business Name): EDWARD LOPEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2021
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 HUNTINGTON DR
DUARTE CA
91010-2635
US

IV. Provider business mailing address

6204 CITRUS AVE
WHITTIER CA
90601-3210
US

V. Phone/Fax

Practice location:
  • Phone: 626-993-3000
  • Fax:
Mailing address:
  • Phone: 562-906-2685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW134870
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: