Healthcare Provider Details

I. General information

NPI: 1912733890
Provider Name (Legal Business Name): PAUL A LOPEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3097 MOORPARK AVE STE 100
SAN JOSE CA
95128-2543
US

IV. Provider business mailing address

1996 HICKS AVE
SAN JOSE CA
95125-3927
US

V. Phone/Fax

Practice location:
  • Phone: 669-247-6170
  • Fax:
Mailing address:
  • Phone: 408-786-8962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: