Provider Demographics
NPI:1669139358
Name:LOPEZ, BRENDAN AKIRA (ATC)
Entity type:Individual
Prefix:
First Name:BRENDAN
Middle Name:AKIRA
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1731 MICHON DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-5721
Mailing Address - Country:US
Mailing Address - Phone:408-693-9314
Mailing Address - Fax:
Practice Address - Street 1:2281 PLUMMER AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-4700
Practice Address - Country:US
Practice Address - Phone:408-264-1664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20000424132255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer