Healthcare Provider Details

I. General information

NPI: 1578970737
Provider Name (Legal Business Name): CYNTHIA LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2014
Last Update Date: 02/12/2025
Certification Date: 02/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 W LA VETA AVE STE 450
ORANGE CA
92868-4224
US

IV. Provider business mailing address

1120 W LA VETA AVE STE 450
ORANGE CA
92868-4224
US

V. Phone/Fax

Practice location:
  • Phone: 866-476-9025
  • Fax:
Mailing address:
  • Phone: 866-476-9025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: