Provider Demographics
NPI:1932875861
Name:DUPART, CHERYL LOPEZ (MOT)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:LOPEZ
Last Name:DUPART
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8403 PARKSIDE CRES
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-4147
Mailing Address - Country:US
Mailing Address - Phone:847-668-4440
Mailing Address - Fax:
Practice Address - Street 1:710 W 13TH AVE
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-5511
Practice Address - Country:US
Practice Address - Phone:760-208-2520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-20
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22120225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist