Basic Information
| Provider Information | |||||||||
| NPI: | 1205348455 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LOPEZ | ||||||||
| FirstName: | ADRIANA | ||||||||
| MiddleName: | LETICIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4856 LANTE ST | ||||||||
| Address2: | |||||||||
| City: | BALDWIN PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917061946 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6265362409 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11100 VALLEY BLVD STE 116 | ||||||||
| Address2: | |||||||||
| City: | EL MONTE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6264440705 | ||||||||
| FaxNumber: | 6264440710 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2017 | ||||||||
| LastUpdateDate: | 07/05/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.