Provider Demographics
NPI:1285005041
Name:MV LOPEZ RNFA PLLC
Entity Type:Organization
Organization Name:MV LOPEZ RNFA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIVIC
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RNFA
Authorized Official - Phone:817-692-9666
Mailing Address - Street 1:PO BOX 150896
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76108-0896
Mailing Address - Country:US
Mailing Address - Phone:817-692-9666
Mailing Address - Fax:
Practice Address - Street 1:10701 BLUESTONE RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76108-6930
Practice Address - Country:US
Practice Address - Phone:817-692-9666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-19
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX715412174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty