Healthcare Provider Details

I. General information

NPI: 1073448213
Provider Name (Legal Business Name): BERENICE PIMENTEL LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 98TH AVE
OAKLAND CA
94603-2702
US

IV. Provider business mailing address

1364 COLFAX DR
WOODLAND CA
95776-4295
US

V. Phone/Fax

Practice location:
  • Phone: 530-902-0160
  • Fax:
Mailing address:
  • Phone: 530-902-0160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number230265989
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: