Provider Demographics
NPI:1033118013
Name:LUNA-LOPEZ, BRENDA Y (FNP)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:Y
Last Name:LUNA-LOPEZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:448 CASTROVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207-5147
Mailing Address - Country:US
Mailing Address - Phone:210-434-1400
Mailing Address - Fax:210-431-7472
Practice Address - Street 1:448 CASTROVILLE RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-5147
Practice Address - Country:US
Practice Address - Phone:210-434-1400
Practice Address - Fax:210-431-7472
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX638025363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX162492602Medicaid
TX267021YLPSOtherWELLMED MEDICAL GROUP PA
TX8N8225OtherBCBS
Q03756Medicare UPIN
TX267021YLPSOtherWELLMED MEDICAL GROUP PA