Healthcare Provider Details

I. General information

NPI: 1700470051
Provider Name (Legal Business Name): JACQUELYNE ZEPEDA-LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2021
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9645 ARROW RTE STE A
RANCHO CUCAMONGA CA
91730-4554
US

IV. Provider business mailing address

9645 ARROW RTE STE A
RANCHO CUCAMONGA CA
91730-4554
US

V. Phone/Fax

Practice location:
  • Phone: 909-280-7444
  • Fax:
Mailing address:
  • Phone: 909-280-7444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number127811
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: