Basic Information
| Provider Information | |||||||||
| NPI: | 1932875861 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DUPART | ||||||||
| FirstName: | CHERYL | ||||||||
| MiddleName: | LOPEZ | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MOT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8403 PARKSIDE CRES | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921274147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476684440 | ||||||||
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| Practice Location | |||||||||
| Address1: | 710 W 13TH AVE | ||||||||
| Address2: | |||||||||
| City: | ESCONDIDO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920255511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7602082520 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2021 | ||||||||
| LastUpdateDate: | 08/20/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 22120 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.