Healthcare Provider Details

I. General information

NPI: 1942816582
Provider Name (Legal Business Name): PRE-OP MOBILE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2020
Last Update Date: 02/10/2021
Certification Date: 02/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13305 OLD BUTTERFIELD RD
SANTA ROSA VALLEY CA
93012-8840
US

IV. Provider business mailing address

13305 OLD BUTTERFIELD RD
SANTA ROSA VALLEY CA
93012-8840
US

V. Phone/Fax

Practice location:
  • Phone: 805-368-9168
  • Fax:
Mailing address:
  • Phone: 909-809-1004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2278G1100X
TaxonomyGeneral Care Certified Respiratory Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. RONNIE JEFFREY LOPEZ
Title or Position: RESPIRATORY THERAPY
Credential: RRT
Phone: 805-368-9168