Provider Demographics
NPI:1346064128
Name:TEP, BOPHA
Entity type:Individual
Prefix:
First Name:BOPHA
Middle Name:
Last Name:TEP
Suffix:
Gender:
Credentials:
Other - Prefix:DR
Other - First Name:NIKKI
Other - Middle Name:
Other - Last Name:TEP
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:1340 ARNOLD DR STE 110
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-4189
Mailing Address - Country:US
Mailing Address - Phone:925-387-9808
Mailing Address - Fax:
Practice Address - Street 1:1340 ARNOLD DR STE 110
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-4189
Practice Address - Country:US
Practice Address - Phone:925-387-9808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-08
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSB94027357225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Multi-Specialty