MEDICARE: ANGELA ROSALIA LOPEZ LOPEZ OTR/L

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	19249	CA

General Provider Information

NPI Number	:	1710453626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA ROSALIA LOPEZ LOPEZ OTR/L

Provider Business Mailing Address
First Line	:	3288 ADAMS AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92116-1646
Country	:	US
Telephone Number	:	619-356-3117
Fax Number	:

Provider Business Practice Location Address
First Line	:	1415 RIDGEBACK RD STE 2
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91910-6983
Country	:	US
Telephone Number	:	757-650-6636
Fax Number	:

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

Provider Enumeration Date	:	10/17/2018
Last Update Date	:	07/14/2021

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