Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 20094 | CA |
NPI | 1194391847 |
---|---|
Provider Name | Gil Lopez |
First Address | San Diego, CA 92126-2080 |
Second Address | San Diego, CA 92126-2080 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2021 |
Last Update Date | 02/06/2021 |