Provider Demographics
NPI:1063171155
Name:LOPEZ, JASMINE JAYLEE
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:JAYLEE
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 1:1700 E SAINT ANDREW PL
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-4933
Mailing Address - Country:US
Mailing Address - Phone:714-667-9757
Mailing Address - Fax:
Practice Address - Street 1:1700 E SAINT ANDREW PL
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-4933
Practice Address - Country:US
Practice Address - Phone:714-667-7610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-15
Last Update Date:2025-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist