=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619872637
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALEXIS LOPEZ BA, MA, ED.S
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/09/2026
-----------------------------------------------------
Last Update Date | 10/09/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2425 16TH ST
-----------------------------------------------------
City | SANTA MONICA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90405-2621
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-452-2326
-----------------------------------------------------
Fax | 310-452-5352
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 821 11TH ST APT 2
-----------------------------------------------------
City | SANTA MONICA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90403-1694
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-452-2326
-----------------------------------------------------
Fax | 310-452-5352
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TS0200X
-----------------------------------------------------
Taxonomy Name | School Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------