Provider Demographics
NPI:1578611208
Name:LOPEZ, NORMA LINDA (CERTIFIED PEDORTHIST)
Entity Type:Individual
Prefix:
First Name:NORMA
Middle Name:LINDA
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:CERTIFIED PEDORTHIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 N MITCHELL ST
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78582-2508
Mailing Address - Country:US
Mailing Address - Phone:956-487-9932
Mailing Address - Fax:956-487-9983
Practice Address - Street 1:511 W 2ND ST
Practice Address - Street 2:
Practice Address - City:RIO GRANDE CITY
Practice Address - State:TX
Practice Address - Zip Code:78582-3609
Practice Address - Country:US
Practice Address - Phone:956-487-9932
Practice Address - Fax:956-487-9983
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0061531332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies