Provider Demographics
NPI:1588079099
Name:TOBAR-LOPEZ, CARMEN (BA)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:TOBAR-LOPEZ
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:CARMEN
Other - Middle Name:
Other - Last Name:TOBAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:21545 CENTRE POINTE PKWY
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91350-2947
Mailing Address - Country:US
Mailing Address - Phone:661-255-6847
Mailing Address - Fax:661-362-1030
Practice Address - Street 1:21545 CENTRE POINTE PKWY
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91350-2947
Practice Address - Country:US
Practice Address - Phone:661-255-6847
Practice Address - Fax:661-362-1030
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-23
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner