Healthcare Provider Details

I. General information

NPI: 1083539167
Provider Name (Legal Business Name): CECILY LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 NORIEGA ST
SAN FRANCISCO CA
94122-4046
US

IV. Provider business mailing address

1500 KIRKHAM ST
SAN FRANCISCO CA
94122-3437
US

V. Phone/Fax

Practice location:
  • Phone: 650-731-5439
  • Fax:
Mailing address:
  • Phone: 510-565-4716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number21904
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: