Healthcare Provider Details

I. General information

NPI: 1659289841
Provider Name (Legal Business Name): JAZMIN LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 W TOWN AND COUNTRY RD
ORANGE CA
92868-4600
US

IV. Provider business mailing address

119 S MAGNOLIA AVE APT 16
ANAHEIM CA
92804-2177
US

V. Phone/Fax

Practice location:
  • Phone: 657-565-3259
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: