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General NPI Number Information
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NPI Number | 1033003850
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Entity Type | Individual
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Provider Name | AUNDRE PADILLA LOPEZ
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Gender |
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Dates
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Enumeration Date | 06/05/2025
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Last Update Date | 06/05/2025
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Provider Practice Location Address
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Address Line | 2601 E THOMAS RD
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City | PHOENIX
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State | AZ
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Zip | 85016-8221
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Country | US
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Telephone | 915-525-3774
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Fax |
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Provider Business Mailing Address
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Address Line | 1750 S ALMA SCHOOL RD APT 206
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City | MESA
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State | AZ
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Zip | 85210-3018
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Country | US
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Telephone | 915-525-3774
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OTA-050149
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License Number State | AZ
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