Healthcare Provider Details

I. General information

NPI: 1932714508
Provider Name (Legal Business Name): MS. SABRINA NATALIA LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2020
Last Update Date: 11/29/2023
Certification Date: 11/29/2023
Deactivation Date: 10/04/2023
Reactivation Date: 10/11/2023

III. Provider practice location address

555 NORTH PERRIS BLVD
PERRIS CA
92571
US

IV. Provider business mailing address

555 NORTH PERRIS BLVD
PERRIS CA
92571
US

V. Phone/Fax

Practice location:
  • Phone: 951-436-5300
  • Fax:
Mailing address:
  • Phone: 951-436-5300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number142893
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: