Provider Demographics
NPI:1376573907
Name:LOPEZ, SERGIO J (NP-C, MSN,RNFA-CNOR)
Entity Type:Individual
Prefix:
First Name:SERGIO
Middle Name:J
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:NP-C, MSN,RNFA-CNOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:7535 SUMMERDALE DR
Mailing Address - Street 2:
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77469-4629
Mailing Address - Country:US
Mailing Address - Phone:956-451-2568
Mailing Address - Fax:956-387-0917
Practice Address - Street 1:7535 SUMMERDALE DR
Practice Address - Street 2:
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77469-4629
Practice Address - Country:US
Practice Address - Phone:956-451-2568
Practice Address - Fax:956-387-0917
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX654368163W00000X, 163WR0006X
TXAP124274363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant