Healthcare Provider Details

I. General information

NPI: 1316465800
Provider Name (Legal Business Name): DALILA LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2017
Last Update Date: 05/11/2021
Certification Date: 05/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19401 S VERMONT AVE STE A200
TORRANCE CA
90502
US

IV. Provider business mailing address

19401 S VERMONT AVE STE A200
TORRANCE CA
90502-4418
US

V. Phone/Fax

Practice location:
  • Phone: 310-323-6887
  • Fax:
Mailing address:
  • Phone: 310-323-6887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number83992
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number101347
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: