1245813146 NPI number — AMY ELIZABETH LOPEZ HAD

Table of content: AMY ELIZABETH LOPEZ HAD (NPI 1245813146)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245813146 NPI number — AMY ELIZABETH LOPEZ HAD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOPEZ
Provider First Name:
AMY
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
HAD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
POZO CASTILLO
Provider Other First Name:
AMY
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
HAD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1245813146
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/22/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5555 GARDEN GROVE BLVD STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTMINSTER
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92683-8234
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-898-5732
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 CENTERPOINTE DR STE 9A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA PALMA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90623-2577
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-562-9950
Provider Business Practice Location Address Fax Number:
714-562-9956
Provider Enumeration Date:
04/29/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 237700000X , with the licence number:  HA8648 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: HA8648 . This is a "SPEECH-LANGUAGE PATHOLOGY AND AUDIOLOGY AND HEARING AID DISPENSERS BOARD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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