Healthcare Provider Details

I. General information

NPI: 1619872637
Provider Name (Legal Business Name): ALEXIS LOPEZ BA, MA, ED.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 16TH ST
SANTA MONICA CA
90405-2621
US

IV. Provider business mailing address

821 11TH ST APT 2
SANTA MONICA CA
90403-1694
US

V. Phone/Fax

Practice location:
  • Phone: 310-452-2326
  • Fax: 310-452-5352
Mailing address:
  • Phone: 310-452-2326
  • Fax: 310-452-5352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: