Provider Demographics
NPI:1083213680
Name:LOPEZ, CASSANDRA MABEL (MS, RBT)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:MABEL
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MS, RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 N RAITT ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92703-2924
Mailing Address - Country:US
Mailing Address - Phone:714-583-2357
Mailing Address - Fax:
Practice Address - Street 1:1835 W ORANGEWOOD AVE STE 323
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-2094
Practice Address - Country:US
Practice Address - Phone:805-475-8211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-23
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician