Provider Demographics
NPI:1487674834
Name:LOPEZ-GUERRA, ALICIA M (MD)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:M
Last Name:LOPEZ-GUERRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 SANTE FE
Mailing Address - Street 2:#204
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-2287
Mailing Address - Country:US
Mailing Address - Phone:361-882-1795
Mailing Address - Fax:361-882-1796
Practice Address - Street 1:1315 SANTE FE
Practice Address - Street 2:#204
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-2287
Practice Address - Country:US
Practice Address - Phone:361-882-1795
Practice Address - Fax:361-882-1796
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD8328208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP000M2328OtherPRIVATE INSURANCE
TXP000M2328OtherPRIVATE INSURANCE