Provider Demographics
NPI:1457474389
Name:ANABEL LOPEZ CORONADO MD PA
Entity Type:Organization
Organization Name:ANABEL LOPEZ CORONADO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD PA
Authorized Official - Prefix:
Authorized Official - First Name:ANABEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ CORONADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-633-1124
Mailing Address - Street 1:2150 TRAWOOD DR
Mailing Address - Street 2:A 100
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79935-3322
Mailing Address - Country:US
Mailing Address - Phone:615-633-1124
Mailing Address - Fax:915-633-1336
Practice Address - Street 1:2150 TRAWOOD DR
Practice Address - Street 2:A 100
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79935-3322
Practice Address - Country:US
Practice Address - Phone:615-633-1124
Practice Address - Fax:915-633-1336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-07
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00X862Medicare PIN