Provider Demographics
NPI:1912881681
Name:LOPEZ, MARISOL
Entity type:Individual
Prefix:
First Name:MARISOL
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 1:550 ORANGE AVE UNIT 317
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-7008
Mailing Address - Country:US
Mailing Address - Phone:562-661-7997
Mailing Address - Fax:
Practice Address - Street 1:550 ORANGE AVE UNIT 317
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-7008
Practice Address - Country:US
Practice Address - Phone:562-661-7997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor