=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689818833
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NORMA ALICIA LOPEZ-RIVERA MS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/30/2009
-----------------------------------------------------
Last Update Date | 02/14/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 203 E BADILLO ST
-----------------------------------------------------
City | COVINA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91723-2116
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-732-1111
-----------------------------------------------------
Fax | 626-732-1112
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 203 E BADILLO ST
-----------------------------------------------------
City | COVINA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91723-2116
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-732-1111
-----------------------------------------------------
Fax | 626-732-1112
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 15105
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------