Provider Demographics
NPI:1518907047
Name:HUERTAS LOPEZ, OTONIEL (MD)
Entity Type:Individual
Prefix:
First Name:OTONIEL
Middle Name:
Last Name:HUERTAS LOPEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7557 RAMBLER RD STE 100
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-2388
Mailing Address - Country:US
Mailing Address - Phone:972-279-9000
Mailing Address - Fax:972-279-9008
Practice Address - Street 1:7557 RAMBLER RD
Practice Address - Street 2:SUITE 100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4142
Practice Address - Country:US
Practice Address - Phone:972-279-9000
Practice Address - Fax:972-279-9008
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9806207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX17647Medicare UPIN