Provider Demographics
NPI:1679898761
Name:LOPEZ, LATOYA
Entity type:Individual
Prefix:
First Name:LATOYA
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-4523
Mailing Address - Country:US
Mailing Address - Phone:415-474-7310
Mailing Address - Fax:415-922-9418
Practice Address - Street 1:1263 MISSION ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-2705
Practice Address - Country:US
Practice Address - Phone:415-502-3000
Practice Address - Fax:415-514-6466
Is Sole Proprietor?:No
Enumeration Date:2010-03-31
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1063961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical