Provider Demographics
NPI:1386158715
Name:LOPEZ, MAYRA (APCC5898)
Entity type:Individual
Prefix:
First Name:MAYRA
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:APCC5898
Other - Prefix:
Other - First Name:MAYRA
Other - Middle Name:
Other - Last Name:ZARAGOZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:380 COALINGA PLZ
Mailing Address - Street 2:
Mailing Address - City:COALINGA
Mailing Address - State:CA
Mailing Address - Zip Code:93210-1704
Mailing Address - Country:US
Mailing Address - Phone:855-343-1057
Mailing Address - Fax:844-587-6405
Practice Address - Street 1:380 COALINGA PLZ
Practice Address - Street 2:
Practice Address - City:COALINGA
Practice Address - State:CA
Practice Address - Zip Code:93210-1704
Practice Address - Country:US
Practice Address - Phone:855-343-1057
Practice Address - Fax:844-563-6078
Is Sole Proprietor?:No
Enumeration Date:2017-11-21
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA5898101YM0800X
CAAPCC17886101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAPCC17886OtherCALIFORNIA BOAR OF BEHAVIORAL SCIENCES
CAAPCC5898OtherCALIFORNIA BOARD OF BEHAVIORAL SCIENCES