Provider Demographics
NPI:1487462537
Name:LOPEZ, ELISSA EMILY
Entity type:Individual
Prefix:MISS
First Name:ELISSA
Middle Name:EMILY
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 1:11817 DEMING AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-5225
Mailing Address - Country:US
Mailing Address - Phone:323-312-9455
Mailing Address - Fax:
Practice Address - Street 1:11817 DEMING AVE
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-5225
Practice Address - Country:US
Practice Address - Phone:323-312-9455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-20
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician