Provider Demographics
NPI:1346023769
Name:LOPEZ, OSKAR M (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:OSKAR
Middle Name:M
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1645 RIDGE ROCK CT
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-1773
Mailing Address - Country:US
Mailing Address - Phone:619-947-3329
Mailing Address - Fax:
Practice Address - Street 1:3050 N LITCHFIELD RD STE 100
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-7805
Practice Address - Country:US
Practice Address - Phone:623-935-5505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ33179225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist