MEDICARE: IVANA LOPEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2355S0801X	Speech-Language Assistant	3135	CA

General Provider Information

NPI Number	:	1063895779
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IVANA LOPEZ

Provider Business Mailing Address
First Line	:	14772 PIPELINE AVE
Second Line	:
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-6027
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14772 PIPELINE AVE
Second Line	:
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-6027
Country	:	US
Telephone Number	:	909-606-0886
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2015
Last Update Date	:	06/30/2015

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Directions to “ IVANA LOPEZ ” Practice Location

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