Provider Demographics
NPI:1205348455
Name:LOPEZ, ADRIANA LETICIA
Entity type:Individual
Prefix:
First Name:ADRIANA
Middle Name:LETICIA
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4856 LANTE ST
Mailing Address - Street 2:
Mailing Address - City:BALDWIN PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91706-1946
Mailing Address - Country:US
Mailing Address - Phone:626-536-2409
Mailing Address - Fax:
Practice Address - Street 1:11100 VALLEY BLVD STE 116
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731
Practice Address - Country:US
Practice Address - Phone:626-444-0705
Practice Address - Fax:626-444-0710
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-27
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)