Provider Demographics
NPI:1417240433
Name:LOPEZ, MARIELA MELISSA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIELA
Middle Name:MELISSA
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4747 BELLAIRE BLVD STE 375
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-4600
Mailing Address - Country:US
Mailing Address - Phone:832-345-6352
Mailing Address - Fax:
Practice Address - Street 1:4747 BELLAIRE BLVD STE 375
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-4600
Practice Address - Country:US
Practice Address - Phone:832-345-6352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-24
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR1408208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
1417240433OtherPLASTIC SURGERY