MEDICARE: CHERE TRACY LOPEZ RBT

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	106S00000X	Behavior Technician
2	106S00000X	Behavior Technician	RBT-21-182974	CA

General Provider Information

NPI Number	:	1326700162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERE TRACY LOPEZ RBT

Provider Business Mailing Address
First Line	:	4755 RADFORD AVE APT 6
Second Line	:
City	:	VALLEY VILLAGE
State	:	CA
Zip	:	91607-4024
Country	:	US
Telephone Number	:	818-235-4826
Fax Number	:

Provider Business Practice Location Address
First Line	:	5455 WILSHIRE BLVD STE 800
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-4271
Country	:	US
Telephone Number	:	833-669-4222
Fax Number	:

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

Provider Enumeration Date	:	10/08/2021
Last Update Date	:	10/08/2021

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Directions to “ CHERE TRACY LOPEZ RBT” Practice Location

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