Provider Demographics
NPI:1902418213
Name:LOPEZ, MEGAN ALICIA (ATC)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:ALICIA
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4310 SUNNYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-2080
Mailing Address - Country:US
Mailing Address - Phone:951-315-9621
Mailing Address - Fax:
Practice Address - Street 1:5450 VICTORIA AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-3362
Practice Address - Country:US
Practice Address - Phone:951-788-7203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer