Jack Lopez, BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-23-63964 Issued in CA

Practice address

1050 West Lakes Dr #225
PMB #3097
West Covina, CA 91790

Phone

(323) 943-4400

NPI assigned

Dec 4, 2019

Last updated

Nov 12, 2024By the provider in NPPES

Sex

Male

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

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Legendary Behavioral Services

  • Behavior Analyst
  • West Covina, CA
  • NPI 1477378461
  NPD Authorized official

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

{
    "created_epoch": "1575417600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731369600000",
    "number": "1740827195",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1050 LAKES DR STE 225",
            "address_2": "PMB #3097",
            "city": "WEST COVINA",
            "state": "CA",
            "postal_code": "917902910",
            "telephone_number": "323-943-4400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1050 WEST LAKES DR #225",
            "address_2": "PMB #3097",
            "city": "WEST COVINA",
            "state": "CA",
            "postal_code": "91790",
            "telephone_number": "323-943-4400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOPEZ",
        "first_name": "JACK",
        "credential": "BCBA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-12-04",
        "last_updated": "2024-11-12",
        "certification_date": "2024-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "CA",
            "license": "1-23-63964",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Caitlin Leanne Lopez, LPT
• Eduardo Lopez
• Eric Lopez
• Giovanna Lopez
• Irma Lopez
• Lawrence Lopez
• Leticia Lopez
• Lorraine Francis Lopez
• Sidney Matthew Lopez, MD
• Valerie Lopez

• Behavior Analyst in West Covina, CA
• Providers in West Covina, CA by specialty
• Behavior Analyst in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 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.