Provider Demographics
NPI:1053865816
Name:LOPEZ, ELIOT J (PHD)
Entity Type:Individual
Prefix:
First Name:ELIOT
Middle Name:J
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7703 FLOYD CURL DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3901
Mailing Address - Country:US
Mailing Address - Phone:210-450-6120
Mailing Address - Fax:
Practice Address - Street 1:3939 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-2291
Practice Address - Country:US
Practice Address - Phone:210-450-6120
Practice Address - Fax:210-450-6161
Is Sole Proprietor?:No
Enumeration Date:2016-08-10
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36350103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX363422201Medicaid
TX363422202OtherCSHCN
TX363422202OtherCSHCN