Provider Demographics
NPI:1386776201
Name:LOPEZ HERNDON, LORETTA
Entity type:Individual
Prefix:
First Name:LORETTA
Middle Name:
Last Name:LOPEZ HERNDON
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 1:6081 PICKFORD PL APT 2C
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-4536
Mailing Address - Country:US
Mailing Address - Phone:310-237-2236
Mailing Address - Fax:
Practice Address - Street 1:6081 PICKFORD PL APT 2C
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-4536
Practice Address - Country:US
Practice Address - Phone:310-237-2236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2023-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT83999106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist