MEDICARE: MRS. HELEN MACKAY LOPEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OT 10523	CA

General Provider Information

NPI Number	:	1124329990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HELEN MACKAY LOPEZ

Provider Business Mailing Address
First Line	:	4217 OLIVER CT APT 6
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-3924
Country	:	US
Telephone Number	:	760-791-6498
Fax Number	:	619-269-4555

Provider Business Practice Location Address
First Line	:	4217 OLIVER CT APT 6
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-3924
Country	:	US
Telephone Number	:	760-791-6498
Fax Number	:	619-269-4555

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2010
Last Update Date	:	11/10/2010

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