Healthcare Provider Details

I. General information

NPI: 1063831915
Provider Name (Legal Business Name): LILIANA LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2014
Last Update Date: 01/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19401 S VERMONT AVE A-200
TORRANCE CA
90502-1029
US

IV. Provider business mailing address

17240 SAN MATEO ST APT. M6
FOUNTAIN VALLEY CA
92708-3730
US

V. Phone/Fax

Practice location:
  • Phone: 310-323-6887
  • Fax:
Mailing address:
  • Phone: 714-399-1860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: