Active NPI
Nicole Denise Lopez
- Licensed Psychiatric Technician
- Pomona, CA
National Provider Identifier
1386897510
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Psychiatric Technician
- License
- PT34290
- Practice address
- 790 E Bonita Ave
Pomona, CA 91767-1906 - Phone
- (909) 625-7207
- NPI assigned
- Oct 31, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Psychiatric Technician | 167G00000X | PT34290 | CA | Primary |
Addresses
Primary practice location
790 E Bonita Ave
Pomona, CA 91767-1906
Mailing address
790 E Bonita Ave
Pomona, CA 91767-1906
Phone (909) 625-7207
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT34290 | CA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1225411200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1225411200000",
"number": "1386897510",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "790 E BONITA AVE",
"city": "POMONA",
"state": "CA",
"postal_code": "917671906",
"telephone_number": "909-625-7207"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "790 E BONITA AVE",
"city": "POMONA",
"state": "CA",
"postal_code": "917671906",
"telephone_number": "909-625-7207"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LOPEZ",
"first_name": "NICOLE",
"middle_name": "DENISE",
"name_prefix": "Miss",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-10-31",
"last_updated": "2008-10-31",
"status": "A"
},
"taxonomies": [
{
"code": "167G00000X",
"taxonomy_group": "",
"desc": "Licensed Psychiatric Technician",
"state": "CA",
"license": "PT34290",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pomona, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.