Provider Demographics
NPI:1174353395
Name:LOPEZ, CAMILLA CECILIA
Entity type:Individual
Prefix:
First Name:CAMILLA
Middle Name:CECILIA
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 1:7908 MOUNT VERNON ST
Mailing Address - Street 2:
Mailing Address - City:LEMON GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:91945-2920
Mailing Address - Country:US
Mailing Address - Phone:619-867-9149
Mailing Address - Fax:
Practice Address - Street 1:7908 MOUNT VERNON ST
Practice Address - Street 2:
Practice Address - City:LEMON GROVE
Practice Address - State:CA
Practice Address - Zip Code:91945-2920
Practice Address - Country:US
Practice Address - Phone:619-867-9149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician