Provider Demographics
NPI:1508366162
Name:LOPEZ, ROXANNA CANDELA
Entity Type:Individual
Prefix:
First Name:ROXANNA
Middle Name:CANDELA
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 1:7779 ELK RUN
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76901-4948
Mailing Address - Country:US
Mailing Address - Phone:325-374-1184
Mailing Address - Fax:
Practice Address - Street 1:7779 ELK RUN
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76901-4948
Practice Address - Country:US
Practice Address - Phone:325-374-1184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX687874163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse