Provider Demographics
NPI:1508081316
Name:LOPEZ, MONICA EDITH (MD)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:EDITH
Last Name:LOPEZ
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 1:3025 N TARRANT PKWY STE 150
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76177-8633
Mailing Address - Country:US
Mailing Address - Phone:817-416-2229
Mailing Address - Fax:817-416-3667
Practice Address - Street 1:3025 N TARRANT PKWY STE 150
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76177-8633
Practice Address - Country:US
Practice Address - Phone:817-416-2229
Practice Address - Fax:817-416-3667
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM5336207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX795546OtherAETNA
TX8G5673OtherBCBS
TX8G5673OtherBCBS
TXM5336OtherMEDICAL LICENSE NUMBER
TX8G5673OtherBCBS
TX8J6316Medicare PIN