Provider Demographics
NPI:1477016285
Name:LOPEZ, MARIA FERNANDA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:FERNANDA
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3805 W BUSINESS 83
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78552-3521
Mailing Address - Country:US
Mailing Address - Phone:956-230-5135
Mailing Address - Fax:
Practice Address - Street 1:3805 W BUSINESS 83
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78552-3521
Practice Address - Country:US
Practice Address - Phone:956-230-5135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-09
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-19-81949106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician