Individual
JACOB LOPEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
31360 VIA COLINAS STE 104, WESTLAKE VILLAGE, CA 91362-6821
(805) 492-1500
Mailing address
10966 HENDERSON PL, VENTURA, CA 93004-1830
(805) 795-1311
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
50785
CA
Other
Enumeration date
01/14/2022
Last updated
01/14/2022
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