Provider Demographics
NPI:1528606720
Name:LOPEZ, NOEMI (NP)
Entity Type:Individual
Prefix:
First Name:NOEMI
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3002 N BUSINESS 281 STE B
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78541-7162
Mailing Address - Country:US
Mailing Address - Phone:956-383-8300
Mailing Address - Fax:956-383-3006
Practice Address - Street 1:3002 N BUSINESS 281 STE B
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78541-7162
Practice Address - Country:US
Practice Address - Phone:956-383-8300
Practice Address - Fax:956-383-3006
Is Sole Proprietor?:No
Enumeration Date:2019-12-18
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP143992363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160945501Medicaid