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General NPI Number Information
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NPI Number | 1730627175
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Entity Type | Organization
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Legal Business Name | FORTUNA MEDICAL GROUP PHYSICAL THERAPY & REHAB
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Dates
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Enumeration Date | 02/06/2017
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Last Update Date | 02/06/2017
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Provider Practice Location Address
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Address Line | 11510 S FORTUNA RD SUITE A
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City | YUMA
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State | AZ
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Zip | 85367-7886
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Country | US
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Telephone | 928-342-7046
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Fax | 928-342-7018
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Provider Business Mailing Address
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Address Line | 11510 S FORTUNA RD SUITE A
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City | YUMA
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State | AZ
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Zip | 85367-7886
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Country | US
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Telephone | 928-342-7046
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Fax | 928-342-7018
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. OSWALD LOPEZ
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Credential | OSWALD LOPEZ
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Telephone | 928-342-7046
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 158
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License Number State | AZ
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