Provider Demographics
NPI:1043471154
Name:LOPEZ, CHARLES RUBEN (MS, CCC/SLP)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:RUBEN
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:MS, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1518 QUAMASIA AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-3798
Mailing Address - Country:US
Mailing Address - Phone:956-631-9520
Mailing Address - Fax:
Practice Address - Street 1:1518 QUAMASIA AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-3798
Practice Address - Country:US
Practice Address - Phone:956-631-9520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-20
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15404235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist