Provider Demographics
NPI:1477613701
Name:LOPEZ, CARLOS JUNIOR (LVN)
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:JUNIOR
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11025 VISTA DEL SOL DR APT 2256
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79935-4338
Mailing Address - Country:US
Mailing Address - Phone:915-760-7122
Mailing Address - Fax:
Practice Address - Street 1:11525 VISTA DEL SOL DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-5629
Practice Address - Country:US
Practice Address - Phone:915-855-3636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX203074164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse