Healthcare Provider Details

I. General information

NPI: 1316175516
Provider Name (Legal Business Name): ROSANNA LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2009
Last Update Date: 06/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13001 RAMONA BLVD
IRWINDALE CA
91706-3752
US

IV. Provider business mailing address

2436 E RIO VERDE DR
WEST COVINA CA
91791-2167
US

V. Phone/Fax

Practice location:
  • Phone: 626-337-3828
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: