Healthcare Provider Details

I. General information

NPI: 1376456327
Provider Name (Legal Business Name): ALEXA LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3820 AUBURN BLVD STE 100
SACRAMENTO CA
95821-2124
US

IV. Provider business mailing address

1400 W MARLETTE ST SPC 86
IONE CA
95640-9521
US

V. Phone/Fax

Practice location:
  • Phone: 916-300-6576
  • Fax:
Mailing address:
  • Phone: 702-908-1513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: