NPIMap

Organization Active NPI

Fortuna Medical Group Physical Therapy & Rehab

  • Specialist
  • Yuma, AZ
National Provider Identifier
1730627175
Registry record updated Feb 6, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
158 Issued in AZ
Legal business name
FORTUNA MEDICAL GROUP PHYSICAL THERAPY & REHAB
Doing business as
Fortuna Medical Group Physical Therapy & Rehab
Practice address
11510 S Fortuna Rd
Suite a
Yuma, AZ 85367-7886
Phone
(928) 342-7046
Fax
(928) 342-7018
NPI assigned
Feb 6, 2017
Last updated
Feb 6, 2017By the provider in NPPES
Organization subpart
Yes
Parent organization
FORTUNA MEDICAL GROUPAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 6, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Oswald Lopez, OSWALD LOPEZ
Title
President
Phone
(928) 342-7046

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 174400000X 158 AZ Primary

Addresses

Primary practice location

11510 S Fortuna Rd
Suite a
Yuma, AZ 85367-7886

Mailing address

11510 S Fortuna Rd
Suite a
Yuma, AZ 85367-7886
Phone (928) 342-7046

Other identifiers 1

IdentifierTypeStateIssuer
142905MedicaidAZ

Other names 1

  • Fortuna Medical Group Physical Therapy & Rehab Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Fortuna Medical Group2 organizations share this tax ID, including this one
Part of
Fortuna Medical Group

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1486339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1486339200000",
    "number": "1730627175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11510 S FORTUNA RD",
            "address_2": "SUITE A",
            "city": "YUMA",
            "state": "AZ",
            "postal_code": "853677886",
            "telephone_number": "928-342-7046",
            "fax_number": "928-342-7018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11510 S FORTUNA RD",
            "address_2": "SUITE A",
            "city": "YUMA",
            "state": "AZ",
            "postal_code": "853677886",
            "telephone_number": "928-342-7046",
            "fax_number": "928-342-7018"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORTUNA MEDICAL GROUP PHYSICAL THERAPY & REHAB",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FORTUNA MEDICAL GROUP",
        "enumeration_date": "2017-02-06",
        "last_updated": "2017-02-06",
        "status": "A",
        "authorized_official_last_name": "LOPEZ",
        "authorized_official_first_name": "OSWALD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "928-342-7046",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "OSWALD LOPEZ"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "AZ",
            "license": "158",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "142905",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fortuna Medical Group Physical Therapy & Rehab",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Yuma, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.