Provider Demographics
NPI:1083369508
Name:LOPEZ, CESAR (HEALTH EDUCATOR)
Entity Type:Individual
Prefix:
First Name:CESAR
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:HEALTH EDUCATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9601 PICKWICK TRL
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76131-1488
Mailing Address - Country:US
Mailing Address - Phone:817-914-2159
Mailing Address - Fax:
Practice Address - Street 1:9601 PICKWICK TRL
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76131-1488
Practice Address - Country:US
Practice Address - Phone:817-914-2159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-14
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
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