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General NPI Number Information
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NPI Number | 1316646342
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Entity Type | Individual
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Provider Name | WALDITRUDEZ LOPEZ
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Gender | Female
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Dates
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Enumeration Date | 02/28/2023
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Last Update Date | 02/28/2023
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Provider Practice Location Address
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Address Line | 23844 VIA JACARA
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City | VALENCIA
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State | CA
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Zip | 91355-2520
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Country | US
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Telephone | 818-381-3449
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Fax |
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Provider Business Mailing Address
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Address Line | 15562 SANDRA LN
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City | SYLMAR
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State | CA
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Zip | 91342-3575
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Country | US
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Telephone | 818-381-3449
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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 | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 197601592
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License Number State | CA
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