Healthcare Provider Details

I. General information

NPI: 1275018343
Provider Name (Legal Business Name): YESENIA LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2018
Last Update Date: 09/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 S FAIR OAKS AVE STE 313
PASADENA CA
91105-2084
US

IV. Provider business mailing address

PO BOX 10894
BURBANK CA
91510-0894
US

V. Phone/Fax

Practice location:
  • Phone: 818-554-8475
  • Fax:
Mailing address:
  • Phone: 818-554-8475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: