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General NPI Number Information
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NPI Number | 1346705225
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Entity Type | Individual
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Provider Name | JENNIFER ESMERALDA LOPEZ
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Gender | Female
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Dates
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Enumeration Date | 02/05/2019
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Last Update Date | 02/26/2019
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Provider Practice Location Address
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Address Line | 2323A E PALMDALE BLVD
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City | PALMDALE
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State | CA
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Zip | 93550-4957
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Country | US
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Telephone | 661-223-3800
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Fax |
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Provider Business Mailing Address
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Address Line | 2124 PENNSYLVANIA AVE
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City | COLTON
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State | CA
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Zip | 92324-1036
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Country | US
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Telephone | 562-325-7647
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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 | ASW86783
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License Number State | CA
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