Individual
BRENDA JAQUELINE LOPEZ COTA RUIZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
508 S 2ND AVE, COVINA, CA 91723-3012
(626) 974-8123
(626) 974-8198
Mailing address
4043 BIG DALTON AVE, BALDWIN PARK, CA 91706-4309
(626) 393-5181
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
ASW102642
CA
1041C0700X
Clinical Social Worker
Primary
ASW102642
CA
Other
Enumeration date
01/10/2019
Last updated
07/03/2023
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