Provider Demographics
NPI:1639824659
Name:GOPEZ, ALEXANDER (DPT)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:GOPEZ
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7976 LAKEPORT RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-3124
Mailing Address - Country:US
Mailing Address - Phone:858-336-6218
Mailing Address - Fax:
Practice Address - Street 1:3760 CONVOY ST STE 100
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-3743
Practice Address - Country:US
Practice Address - Phone:858-563-9368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-17
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA301726225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist