Provider Demographics
NPI:1073868881
Name:ESTEVEZ LOPEZ, EFRAIN
Entity Type:Individual
Prefix:
First Name:EFRAIN
Middle Name:
Last Name:ESTEVEZ LOPEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11245 SIR WINSTON ST APT 308
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-2459
Mailing Address - Country:US
Mailing Address - Phone:210-577-1164
Mailing Address - Fax:
Practice Address - Street 1:85 NE LOOP 410 STE 130
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-5862
Practice Address - Country:US
Practice Address - Phone:210-298-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29108765146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX531201142Medicaid