Provider Demographics
NPI:1114191483
Name:ELEAZAR LOPEZ
Entity Type:Organization
Organization Name:ELEAZAR LOPEZ
Other - Org Name:WESTERN ALLIANCE MOBILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ELEAZAR
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-488-9616
Mailing Address - Street 1:1205 W MAIN ST STE 3
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78582-4017
Mailing Address - Country:US
Mailing Address - Phone:956-488-9616
Mailing Address - Fax:956-488-0572
Practice Address - Street 1:1205 W MAIN ST STE 3
Practice Address - Street 2:
Practice Address - City:RIO GRANDE CITY
Practice Address - State:TX
Practice Address - Zip Code:78582-4017
Practice Address - Country:US
Practice Address - Phone:956-488-9616
Practice Address - Fax:956-488-0572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0086743332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5649200001Medicare NSC