Provider Demographics
NPI:1174000806
Name:LOPEZ, RUBEN III
Entity Type:Individual
Prefix:
First Name:RUBEN
Middle Name:
Last Name:LOPEZ
Suffix:III
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:PO BOX 796
Mailing Address - Street 2:
Mailing Address - City:PENITAS
Mailing Address - State:TX
Mailing Address - Zip Code:78576-0796
Mailing Address - Country:US
Mailing Address - Phone:956-583-8772
Mailing Address - Fax:
Practice Address - Street 1:18012 SAGO PALM DR STE 4
Practice Address - Street 2:
Practice Address - City:PENITAS
Practice Address - State:TX
Practice Address - Zip Code:78576-7392
Practice Address - Country:US
Practice Address - Phone:956-519-4242
Practice Address - Fax:956-999-8528
Is Sole Proprietor?:No
Enumeration Date:2018-07-25
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX381962355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant