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NPI Code Detail

MEDICARE: KEONNA ALEXANDRA LOPEZ

MEDICARE: KEONNA ALEXANDRA 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
1106H00000XMarriage & Family Therapist158623CA

General Provider Information

NPI Number : 1912855438
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEONNA ALEXANDRA LOPEZ
Provider Business Mailing Address
First Line : 3800 COOLIDGE AVE
Second Line :
City : OAKLAND
State : CA
Zip : 94602-3399
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3800 COOLIDGE AVE
Second Line :
City : OAKLAND
State : CA
Zip : 94602-3399
Country : US
Telephone Number : 510-482-2244
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/19/2026
Last Update Date : 03/24/2026

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Directions to “ KEONNA ALEXANDRA LOPEZ ” Practice Location

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