Individual
JENNIFER A LOPEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
44199 MONROE ST, INDIO, CA 92201-3096
(760) 863-8262
(760) 770-2240
Mailing address
1216 AMALIA AVE, LOS ANGELES, CA 90022-5040
(661) 528-9855
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
—
—
373H00000X
Day Training/Habilitation Specialist
Primary
—
—
Other
Enumeration date
06/21/2021
Last updated
05/15/2025
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