Provider Demographics
NPI:1194399196
Name:LOPEZ, ADRIANA ELENA
Entity Type:Individual
Prefix:
First Name:ADRIANA
Middle Name:ELENA
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2603 CLARK BLVD
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78043-2419
Mailing Address - Country:US
Mailing Address - Phone:956-740-2603
Mailing Address - Fax:
Practice Address - Street 1:3507 JAIME ZAPATA MEMORIAL HWY STE 1&2
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78043-4769
Practice Address - Country:US
Practice Address - Phone:956-753-6355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-14
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34539235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty