Healthcare Provider Details

I. General information

NPI: 1639531312
Provider Name (Legal Business Name): IRIS YOLANDA LOPEZ LUTHI PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 03/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 FAIR OAKS AVE STE 390
SOUTH PASADENA CA
91030-5817
US

IV. Provider business mailing address

625 FAIR OAKS AVE SUITE 390
SOUTH PASADENA CA
91030-2630
US

V. Phone/Fax

Practice location:
  • Phone: 626-449-2484
  • Fax:
Mailing address:
  • Phone: 626-449-2484
  • Fax: 626-449-1107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number28142
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: