Healthcare Provider Details

I. General information

NPI: 1902753734
Provider Name (Legal Business Name): NAYELI LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2026
Last Update Date: 03/11/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4615 W. 103RD ST. OAKLAWN, IL 60453
CHICAGO IL
60453
US

IV. Provider business mailing address

10532 S AVENUE L
CHICAGO IL
60617-6211
US

V. Phone/Fax

Practice location:
  • Phone: 331-229-8839
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: