Provider Demographics
NPI:1548747728
Name:LOPEZ, ABRAHAM JOSE (PHD)
Entity Type:Individual
Prefix:
First Name:ABRAHAM
Middle Name:JOSE
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4040 BROADWAY
Mailing Address - Street 2:SUITE 518
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209
Mailing Address - Country:US
Mailing Address - Phone:210-858-1900
Mailing Address - Fax:210-745-4525
Practice Address - Street 1:1314 E. SONTERRA BLVD
Practice Address - Street 2:SUITE 2208
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258
Practice Address - Country:US
Practice Address - Phone:210-858-1900
Practice Address - Fax:210-745-4525
Is Sole Proprietor?:No
Enumeration Date:2018-07-20
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37915103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist