Healthcare Provider Details

I. General information

NPI: 1518737469
Provider Name (Legal Business Name): JESSICA LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2024
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3580 WILSHIRE BLVD STE 800
LOS ANGELES CA
90010-2505
US

IV. Provider business mailing address

225 SOUTH LAKE AVE, SUITE 300
PASADENA CA
91101
US

V. Phone/Fax

Practice location:
  • Phone: 323-876-0550
  • Fax:
Mailing address:
  • Phone: 626-410-0299
  • 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 StateNULL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: