Provider Demographics
NPI:1427886035
Name:ALTRE, JOHN FREDERICK LOPEZ
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:FREDERICK LOPEZ
Last Name:ALTRE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9008 MOONBEAM AVE
Mailing Address - Street 2:
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-1941
Mailing Address - Country:US
Mailing Address - Phone:818-203-7116
Mailing Address - Fax:
Practice Address - Street 1:2665 PARK CENTER DR STE D
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-6200
Practice Address - Country:US
Practice Address - Phone:805-416-3384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-24
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT25626225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist