Healthcare Provider Details

I. General information

NPI: 1104487867
Provider Name (Legal Business Name): CINTHIA LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2019
Last Update Date: 06/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3569 LEXINGTON AVE
EL MONTE CA
91731-2607
US

IV. Provider business mailing address

528 DUNSVIEW AVE
LA PUENTE CA
91744-4210
US

V. Phone/Fax

Practice location:
  • Phone: 626-453-3399
  • Fax:
Mailing address:
  • Phone: 626-484-9387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number89266
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: