Healthcare Provider Details

I. General information

NPI: 1336967629
Provider Name (Legal Business Name): ALEIDA JASMINE LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2024
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6244 EL CAJON BLVD STE 14
SAN DIEGO CA
92115-3918
US

IV. Provider business mailing address

5500 CAMPANILE DR
SAN DIEGO CA
92182-0001
US

V. Phone/Fax

Practice location:
  • Phone: 619-640-3266
  • Fax:
Mailing address:
  • Phone: 619-594-6865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number140737
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: