Healthcare Provider Details

I. General information

NPI: 1205201845
Provider Name (Legal Business Name): ALBERTO LOPEZ-ROTHWELL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2015
Last Update Date: 12/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

284 PENNSYLVANIA DR 2
WATSONVILLE CA
95076-3768
US

IV. Provider business mailing address

284 PENNSYLVANIA DR 2
WATSONVILLE CA
95076-3768
US

V. Phone/Fax

Practice location:
  • Phone: 831-319-4200
  • Fax: 831-319-4204
Mailing address:
  • Phone: 831-319-4200
  • Fax: 831-319-4204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number274374
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: