Healthcare Provider Details

I. General information

NPI: 1053023085
Provider Name (Legal Business Name): EUDINEL JOSHUA CARLOS LOPEZ DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2022
Last Update Date: 12/21/2022
Certification Date: 12/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6375 W CHARLESTON BLVD BLDG L
LAS VEGAS NV
89146-1139
US

IV. Provider business mailing address

10310 BROOKE RISE AVE
LAS VEGAS NV
89166-5176
US

V. Phone/Fax

Practice location:
  • Phone: 702-259-1903
  • Fax:
Mailing address:
  • Phone: 718-687-3827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4889
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: