Provider Demographics
NPI:1447795729
Name:LOPEZ SEPULVEDA PRIMARY CARE PLLC
Entity Type:Organization
Organization Name:LOPEZ SEPULVEDA PRIMARY CARE PLLC
Other - Org Name:CLINICA TU SALUD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAXEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ SEPULVEDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-887-3235
Mailing Address - Street 1:245 E GRAUWYLER RD STE 122
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-2639
Mailing Address - Country:US
Mailing Address - Phone:972-887-3235
Mailing Address - Fax:972-887-3197
Practice Address - Street 1:245 E GRAUWYLER RD
Practice Address - Street 2:SUITE 122
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-2639
Practice Address - Country:US
Practice Address - Phone:972-887-3235
Practice Address - Fax:972-887-3197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-22
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ5020207Q00000X
TX5020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty