Individual
GWENDOLYN LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
840 N AVENUE 66, LOS ANGELES, CA 90042-1508
(626) 395-7100
(626) 628-0040
Mailing address
100 W WALNUT ST STE 375, PASADENA, CA 91124-0001
(626) 395-7100
(323) 316-9151
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
1316570351
CA
225400000X
Rehabilitation Practitioner
1316570351
CA
373H00000X
Day Training/Habilitation Specialist
Primary
1316570351
CA
Other
Enumeration date
02/18/2020
Last updated
05/14/2025
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