Provider Demographics
NPI:1104174010
Name:CEBALLOS-LOPEZ, KARLA YARELI (ED D)
Entity type:Individual
Prefix:DR
First Name:KARLA
Middle Name:YARELI
Last Name:CEBALLOS-LOPEZ
Suffix:
Gender:F
Credentials:ED D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 HUMBOLDT AVE
Mailing Address - Street 2:
Mailing Address - City:CHOWCHILLA
Mailing Address - State:CA
Mailing Address - Zip Code:93610-3199
Mailing Address - Country:US
Mailing Address - Phone:559-665-1331
Mailing Address - Fax:
Practice Address - Street 1:805 HUMBOLDT AVE
Practice Address - Street 2:
Practice Address - City:CHOWCHILLA
Practice Address - State:CA
Practice Address - Zip Code:93610-3199
Practice Address - Country:US
Practice Address - Phone:559-665-1331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-27
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool