Provider Demographics
NPI:1285429423
Name:LOPEZ, ADRIAN ELENES
Entity type:Individual
Prefix:
First Name:ADRIAN
Middle Name:ELENES
Last Name:LOPEZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 N 5TH PL
Mailing Address - Street 2:
Mailing Address - City:PORT HUENEME
Mailing Address - State:CA
Mailing Address - Zip Code:93041-2512
Mailing Address - Country:US
Mailing Address - Phone:805-512-6435
Mailing Address - Fax:
Practice Address - Street 1:1245 N 5TH PL
Practice Address - Street 2:
Practice Address - City:PORT HUENEME
Practice Address - State:CA
Practice Address - Zip Code:93041-2512
Practice Address - Country:US
Practice Address - Phone:805-512-6435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician