Healthcare Provider Details

I. General information

NPI: 1336766484
Provider Name (Legal Business Name): CHRISTIAN IVAN LOPEZ FLORES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2020
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3663 MARTIN LUTHER KING JR BLVD
LYNWOOD CA
90262-3506
US

IV. Provider business mailing address

4416 ELIZABETH ST APT 2
CUDAHY CA
90201-5760
US

V. Phone/Fax

Practice location:
  • Phone: 310-900-8490
  • Fax: 310-900-8889
Mailing address:
  • Phone: 323-910-9179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: