Healthcare Provider Details

I. General information

NPI: 1326528704
Provider Name (Legal Business Name): SHELLI ANN LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHELLI ANN HERNANDEZ

II. Dates (important events)

Enumeration Date: 08/15/2018
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date: 08/15/2022
Reactivation Date: 09/21/2022

III. Provider practice location address

324 E BIXBY RD
LONG BEACH CA
90807-3432
US

IV. Provider business mailing address

324 E BIXBY RD
LONG BEACH CA
90807-3432
US

V. Phone/Fax

Practice location:
  • Phone: 562-595-8111
  • Fax:
Mailing address:
  • Phone: 562-595-8111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: