Provider Demographics
NPI:1982304317
Name:CRUZ-LOPEZ, MARIE SALAMANCA (COTA)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:SALAMANCA
Last Name:CRUZ-LOPEZ
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:838 PINE AVE UNIT 314
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-5828
Mailing Address - Country:US
Mailing Address - Phone:310-927-2677
Mailing Address - Fax:
Practice Address - Street 1:1020 TERMINO AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-4123
Practice Address - Country:US
Practice Address - Phone:562-433-6791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOTA316225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation