MEDICARE: SONIA 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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1891627121
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SONIA LOPEZ

Provider Business Mailing Address
First Line	:	100 N PACIFIC COAST HWY STE 1400
Second Line	:
City	:	EL SEGUNDO
State	:	CA
Zip	:	90245-5602
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10065 OLD GROVE RD STE 102
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92131-1664
Country	:	US
Telephone Number	:	858-290-6122
Fax Number	:	855-568-2494

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

Provider Enumeration Date	:	06/01/2026
Last Update Date	:	06/01/2026

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Directions to “ SONIA LOPEZ ” Practice Location

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