Healthcare Provider Details

I. General information

NPI: 1174439152
Provider Name (Legal Business Name): GRANT ALLEN OPPER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10459 MOUNTAIN VIEW AVE STE G
LOMA LINDA CA
92354-2033
US

IV. Provider business mailing address

10459 MOUNTAIN VIEW AVE STE G
LOMA LINDA CA
92354-2033
US

V. Phone/Fax

Practice location:
  • Phone: 909-478-9508
  • Fax: 909-478-9518
Mailing address:
  • Phone: 909-478-9508
  • Fax: 909-478-9518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number310862
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: