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General NPI Number Information
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NPI Number | 1295459402
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Entity Type | Individual
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Provider Name | DIANA ALISE LOPEZ LCSW
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Gender | Female
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Dates
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Enumeration Date | 09/30/2022
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Last Update Date | 09/30/2022
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Provider Practice Location Address
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Address Line | 287 LORTON AVE
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City | BURLINGAME
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State | CA
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Zip | 94010-4203
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Country | US
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Telephone | 800-505-5972
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Fax |
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Provider Business Mailing Address
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Address Line | 17240 OLIVE ST P.O. BOX #2186
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City | HESPERIA
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State | CA
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Zip | 92345
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149.023056
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 109927
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License Number State | CA
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