Healthcare Provider Details

I. General information

NPI: 1700676103
Provider Name (Legal Business Name): EMILIA LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2025
Last Update Date: 01/26/2026
Certification Date: 01/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8282 WHITE OAK AVE STE 107
RANCHO CUCAMONGA CA
91730-7681
US

IV. Provider business mailing address

3526 SUNNY HILLS DR
NORCO CA
92860-2254
US

V. Phone/Fax

Practice location:
  • Phone: 909-586-0509
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number28595
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: