Individual
WALDITRUDEZ LOPEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
23844 VIA JACARA, VALENCIA, CA 91355-2520
(818) 381-3449
Mailing address
15562 SANDRA LN, SYLMAR, CA 91342-3575
(818) 381-3449
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
197601592
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
197601592
—
CA
Enumeration date
02/28/2023
Last updated
02/28/2023
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