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NPI Code Detail

MEDICARE: DIANA TRINIDAD LOPEZ JIMENEZ

MEDICARE: DIANA TRINIDAD LOPEZ JIMENEZ
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
1103K00000XBehavior Analyst
21041C0700XClinical Social Worker110885CA

General Provider Information

NPI Number : 1174018808
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIANA TRINIDAD LOPEZ JIMENEZ
Provider Business Mailing Address
First Line : 300 W WINTON AVE
Second Line :
City : HAYWARD
State : CA
Zip : 94544-1137
Country : US
Telephone Number : 510-963-2067
Fax Number :
Provider Business Practice Location Address
First Line : 300 W WINTON AVE
Second Line :
City : HAYWARD
State : CA
Zip : 94544-1137
Country : US
Telephone Number : 510-963-2067
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/26/2018
Last Update Date : 04/04/2025

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Directions to “ DIANA TRINIDAD LOPEZ JIMENEZ ” Practice Location

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