Healthcare Provider Details

I. General information

NPI: 1275107393
Provider Name (Legal Business Name): ADRIAN RAUL LOPEZ-MARQUEZ B.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2021
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 MARENGO ST
LOS ANGELES CA
90033-1317
US

IV. Provider business mailing address

919 1ST ST
SAN FERNANDO CA
91340-2957
US

V. Phone/Fax

Practice location:
  • Phone: 323-276-6400
  • Fax:
Mailing address:
  • Phone: 818-256-1124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number123860
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: