Healthcare Provider Details

I. General information

NPI: 1720995426
Provider Name (Legal Business Name): CRYSTAL ELAINE LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2045 S SAN JACINTO AVE
SAN JACINTO CA
92583-5626
US

IV. Provider business mailing address

29165 TOPEKA CIR
WINCHESTER CA
92596-9627
US

V. Phone/Fax

Practice location:
  • Phone: 951-443-7499
  • Fax:
Mailing address:
  • Phone: 951-443-7499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: