MEDICARE: NICOLE ANDREA LOPEZ CMT

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	225700000X	Massage Therapist		CA

General Provider Information

NPI Number	:	1770430134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE ANDREA LOPEZ CMT

Provider Business Mailing Address
First Line	:	4029 BAYWOOD ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90039-1237
Country	:	US
Telephone Number	:	818-314-3255
Fax Number	:

Provider Business Practice Location Address
First Line	:	4029 BAYWOOD ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90039-1237
Country	:	US
Telephone Number	:	818-314-3255
Fax Number	:

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

Provider Enumeration Date	:	03/14/2026
Last Update Date	:	03/14/2026

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Directions to “ NICOLE ANDREA LOPEZ CMT” Practice Location

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