Organization
FORTUNA MEDICAL GROUP PHYSICAL THERAPY & REHAB
Active
Parent organization
FORTUNA MEDICAL GROUP
Other names
Fortuna Medical Group Physical Therapy & Rehab
Organization subpart
Yes
Provider details
NPI number
Legal business name
FORTUNA MEDICAL GROUP
Authorized official
MR. OSWALD LOPEZ OSWALD LOPEZ (PRESIDENT)
(928) 342-7046
Entity
Organization
Contact information
Practice address
11510 S FORTUNA RD, SUITE A, YUMA, AZ 85367-7886
(928) 342-7046
(928) 342-7018
Mailing address
11510 S FORTUNA RD, SUITE A, YUMA, AZ 85367-7886
(928) 342-7046
(928) 342-7018
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
158
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
142905
—
AZ
Enumeration date
02/06/2017
Last updated
02/06/2017
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