Jissel Guadalupe Olea Lopez

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

17101 Issued in CA

Practice address

1750 5TH Avenue
San Diego, CA 92101

Phone

(619) 515-2588

NPI assigned

Oct 28, 2024

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Family Health Centers of San Diego Inc

  dba Fifth Avenue Behavioral Health Center

  • Federally Qualified Health Center (FQHC)
  • San Diego, CA
  • NPI 1538590781
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1730073600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730073600000",
    "number": "1194547521",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4164 SAN MIGUEL AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921131842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1750 5TH AVENUE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "92101",
            "telephone_number": "619-515-2588"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLEA LOPEZ",
        "first_name": "JISSEL",
        "middle_name": "GUADALUPE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-10-28",
        "last_updated": "2024-10-28",
        "certification_date": "2024-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "17101",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Old Town Academy
• Ariana Old
• Jennifer Robyn Old, PHARMD
• Reid Oldenburg, MD, PHD
• Robin Marie Oldenburg, NP
• Jenelle Olea
• Paulina Olech, LPC
• Jerrold Michael Olefsky, M.D.
• Oleg M. Gavrilyuk, M.D., PC
• Brian Oleksy, DDS, MD

• Mental Health Counselor in San Diego, CA
• Providers in San Diego, CA by specialty
• Mental Health Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.