Healthcare Provider Details

I. General information

NPI: 1366989675
Provider Name (Legal Business Name): MONIQUE LOPEZ PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2017
Last Update Date: 01/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 E FOOTHILL BLVD STE 100
ARCADIA CA
91006-2314
US

IV. Provider business mailing address

1801 GARVEY AVE APT 304
ALHAMBRA CA
91803-5218
US

V. Phone/Fax

Practice location:
  • Phone: 626-445-2400
  • Fax: 626-445-2419
Mailing address:
  • Phone: 949-606-6998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT292274
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: