Healthcare Provider Details

I. General information

NPI: 1477464766
Provider Name (Legal Business Name): KENNEDY LOPEZ CAMPBELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12501 IMPERIAL HWY STE 500A
NORWALK CA
90650-3179
US

IV. Provider business mailing address

20415 OSAGE AVE APT A
TORRANCE CA
90503-2622
US

V. Phone/Fax

Practice location:
  • Phone: 310-492-3235
  • Fax:
Mailing address:
  • Phone: 310-492-3235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: