Provider Demographics
NPI:1396176921
Name:LOPEZ, MARIBEL MERCEDES
Entity type:Individual
Prefix:
First Name:MARIBEL
Middle Name:MERCEDES
Last Name:LOPEZ
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 1:2886 WAGNER CT
Mailing Address - Street 2:
Mailing Address - City:ALTADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91001-4614
Mailing Address - Country:US
Mailing Address - Phone:626-710-8674
Mailing Address - Fax:
Practice Address - Street 1:225 E SANTA CLARA ST
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-7233
Practice Address - Country:US
Practice Address - Phone:866-351-8887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-08
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst