Provider Demographics
NPI:1770457608
Name:LOPEZ, GABRIELLE ANGELIQUE (RADT-L)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:ANGELIQUE
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:RADT-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13378 KYLE DR
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-5412
Mailing Address - Country:US
Mailing Address - Phone:805-468-5818
Mailing Address - Fax:
Practice Address - Street 1:13941 COURAGE ST
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-8757
Practice Address - Country:US
Practice Address - Phone:951-497-3655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-02
Last Update Date:2025-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1477000822101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)