Provider Demographics
NPI:1497493399
Name:LOPEZ, CLARISSA DANILLE
Entity Type:Individual
Prefix:
First Name:CLARISSA
Middle Name:DANILLE
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CLARISSA
Other - Middle Name:DANIELLE
Other - Last Name:DALTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18231 LODGEPOLE PINE ST
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-5234
Mailing Address - Country:US
Mailing Address - Phone:713-653-4393
Mailing Address - Fax:
Practice Address - Street 1:18231 LODGEPOLE PINE ST
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-5234
Practice Address - Country:US
Practice Address - Phone:713-653-4393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-22
Last Update Date:2022-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program