Provider Demographics
NPI:1144400243
Name:AMBULO, PAUL ANDRE LOPEZ (PT)
Entity Type:Individual
Prefix:
First Name:PAUL ANDRE
Middle Name:LOPEZ
Last Name:AMBULO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13151 BROOKHURST ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-1079
Mailing Address - Country:US
Mailing Address - Phone:562-481-7833
Mailing Address - Fax:
Practice Address - Street 1:13151 BROOKHURST ST
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-1079
Practice Address - Country:US
Practice Address - Phone:562-481-7833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-07
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist