Provider Demographics
NPI:1134396062
Name:LOPEZ, RAMON P JR (MPT)
Entity type:Individual
Prefix:
First Name:RAMON
Middle Name:P
Last Name:LOPEZ
Suffix:JR
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1426 AVIATION BLVD
Mailing Address - Street 2:STE 204
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-4002
Mailing Address - Country:US
Mailing Address - Phone:310-798-8899
Mailing Address - Fax:
Practice Address - Street 1:1426 AVIATION BLVD
Practice Address - Street 2:STE 204
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-4002
Practice Address - Country:US
Practice Address - Phone:310-798-8899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-09
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT26118225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT26118OtherPHYSICAL THERAPY BOARD OF CALIFORNIA