Basic Information
| Provider Information | |||||||||
| NPI: | 1104487867 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LOPEZ | ||||||||
| FirstName: | CINTHIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 528 DUNSVIEW AVE | ||||||||
| Address2: | |||||||||
| City: | LA PUENTE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917444210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6264849387 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3569 LEXINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | EL MONTE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917312607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6264533399 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2019 | ||||||||
| LastUpdateDate: | 06/24/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 89266 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.