Individual
JENNIFER LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
790 E BONITA AVE, POMONA, CA 91767-1906
(909) 625-7207
Mailing address
11063 WESLEY AVE, MONTCLAIR, CA 91763-6092
(909) 247-8982
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
ASW110919
CA
104100000X
Social Worker
Primary
ASW110919
CA
225400000X
Rehabilitation Practitioner
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/31/2020
Last updated
07/10/2023
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