Provider Demographics
NPI:1710453626
Name:LOPEZ LOPEZ, ANGELA ROSALIA (OTR/L)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:ROSALIA
Last Name:LOPEZ LOPEZ
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3288 ADAMS AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-1646
Mailing Address - Country:US
Mailing Address - Phone:619-356-3117
Mailing Address - Fax:
Practice Address - Street 1:1415 RIDGEBACK RD STE 2
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-6983
Practice Address - Country:US
Practice Address - Phone:757-650-6636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-17
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19249225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist