Provider Demographics
NPI:1417408782
Name:LOPEZ, CRISTAL (CSFA, LSA)
Entity Type:Individual
Prefix:
First Name:CRISTAL
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:CSFA, LSA
Other - Prefix:
Other - First Name:CRISTAL
Other - Middle Name:
Other - Last Name:ELLIOT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1000 N DAVIS DR STE B
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-3202
Mailing Address - Country:US
Mailing Address - Phone:817-513-0797
Mailing Address - Fax:
Practice Address - Street 1:1000 N DAVIS DR STE B
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-3202
Practice Address - Country:US
Practice Address - Phone:817-513-0797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-20
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA000678246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant