Provider Demographics
NPI:1821872243
Name:LOPEZ HERRERA, EDGAR (PT, DPT)
Entity Type:Individual
Prefix:
First Name:EDGAR
Middle Name:
Last Name:LOPEZ HERRERA
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:N/A
Mailing Address - Street 1:1502 COUGAR DR
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93905-4719
Mailing Address - Country:US
Mailing Address - Phone:831-229-4232
Mailing Address - Fax:
Practice Address - Street 1:400 CARLTON AVE STE 100
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2629
Practice Address - Country:US
Practice Address - Phone:949-716-5050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3046802251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic