Healthcare Provider Details

I. General information

NPI: 1629912894
Provider Name (Legal Business Name): BRITNEY NOELLE LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2026
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1452 N COLTSFOOT AVE
KUNA ID
83634-1039
US

IV. Provider business mailing address

1452 N COLTSFOOT AVE
KUNA ID
83634-1039
US

V. Phone/Fax

Practice location:
  • Phone: 805-428-5766
  • Fax:
Mailing address:
  • Phone: 805-428-5766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number138168
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5971589
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: