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General NPI Number Information
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NPI Number | 1659203974
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Entity Type | Individual
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Provider Name | LIZETH MAHALALEEL LOPEZ GASTELUM LICENCIADO
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Gender | Female
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Dates
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Enumeration Date | 06/01/2026
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Last Update Date | 06/01/2026
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Provider Practice Location Address
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Address Line | 16485 N STADIUM WAY UNIT 1091
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City | SURPRISE
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State | AZ
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Zip | 85374-4380
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Country | US
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Telephone | 510-807-8567
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Fax |
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Provider Business Mailing Address
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Address Line | 254 E 2ND ST PMB87 356
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City | CALEXICO
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State | CA
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Zip | 92231
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Country | US
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Telephone | 510-807-8567
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 25-439749
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License Number State | CA
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