Healthcare Provider Details

I. General information

NPI: 1497678460
Provider Name (Legal Business Name): NEREYDA REYLIN LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 N RIVERSIDE AVE
RIALTO CA
92376-5923
US

IV. Provider business mailing address

2851 S LA CADENA DR SPC 147
COLTON CA
92324-3821
US

V. Phone/Fax

Practice location:
  • Phone: 877-323-4283
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberW9222003
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: