Provider Demographics
NPI:1528648284
Name:LOPEZ, DIANA HELEN (PMHNP)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:HELEN
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 W LEMON AVE STE 31
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-6152
Mailing Address - Country:US
Mailing Address - Phone:323-410-0021
Mailing Address - Fax:
Practice Address - Street 1:50 W LEMON AVE STE 31
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-6152
Practice Address - Country:US
Practice Address - Phone:323-410-0021
Practice Address - Fax:323-410-2001
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-08
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95022261363LP0808X
CA733239363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95022261OtherPSYCHIATRIC MENTAL HEALTH NURSE PRACTITIONER