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NPI Code Detail

MEDICARE: BERNICE LOPEZ PTA

MEDICARE: BERNICE LOPEZ PTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy Assistant3456CA

General Provider Information

NPI Number : 1952502973
Entity Type Code : Individual
Provider Name (Legal Business Name) : BERNICE LOPEZ PTA
Provider Business Mailing Address
First Line : 16844 EAST SAM GERRY DRIVE
Second Line :
City : LA PUENTE
State : CA
Zip : 91744
Country : US
Telephone Number : 626-641-0064
Fax Number :
Provider Business Practice Location Address
First Line : 4655 RUFFNER ST STE 270
Second Line :
City : SAN DIEGO
State : CA
Zip : 92111-2276
Country : US
Telephone Number : 800-787-6787
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/29/2007
Last Update Date : 07/08/2007

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