Provider Demographics
NPI:1598044513
Name:LOPEZ, DIANA PATRICIA (RPT)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:PATRICIA
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3167 RANCHO VISTA BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-5517
Mailing Address - Country:US
Mailing Address - Phone:661-266-9578
Mailing Address - Fax:
Practice Address - Street 1:3167 RANCHO VISTA BLVD STE D
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-5517
Practice Address - Country:US
Practice Address - Phone:661-266-9578
Practice Address - Fax:661-266-2270
Is Sole Proprietor?:No
Enumeration Date:2011-08-08
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT12709225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist