Healthcare Provider Details

I. General information

NPI: 1063935567
Provider Name (Legal Business Name): CAITLIN LEANNE LOPEZ LPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2017
Last Update Date: 09/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 E THELBORN ST
WEST COVINA CA
91791-1442
US

IV. Provider business mailing address

7246 REMMET AVE
CANOGA PARK CA
91303-1531
US

V. Phone/Fax

Practice location:
  • Phone: 626-915-3844
  • Fax: 626-915-3845
Mailing address:
  • Phone: 818-206-0360
  • Fax: 818-206-0370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License Number40399
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: