Provider Demographics
NPI:1679968895
Name:LULE LOPEZ, MAYRA P (BCBA)
Entity type:Individual
Prefix:MISS
First Name:MAYRA
Middle Name:P
Last Name:LULE LOPEZ
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21730 GRACE AVE
Mailing Address - Street 2:101
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-2773
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:21730 GRACE AVE
Practice Address - Street 2:101
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-2773
Practice Address - Country:US
Practice Address - Phone:111-111-1111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-03
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1149506103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst