Healthcare Provider Details

I. General information

NPI: 1427666478
Provider Name (Legal Business Name): ELOISA LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2020
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15339 SATICOY ST
VAN NUYS CA
91406-3345
US

IV. Provider business mailing address

6551 FARMDALE AVE
NORTH HOLLYWOOD CA
91606-2618
US

V. Phone/Fax

Practice location:
  • Phone: 818-267-2600
  • Fax:
Mailing address:
  • Phone: 818-854-2060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: