Provider Demographics
NPI:1609655216
Name:LOPEZ, ENRIQUE MARCOS (CPM)
Entity Type:Individual
Prefix:MR
First Name:ENRIQUE
Middle Name:MARCOS
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2230 N VETERANS BLVD STE 240
Mailing Address - Street 2:
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78852-6620
Mailing Address - Country:US
Mailing Address - Phone:830-773-7239
Mailing Address - Fax:830-773-7239
Practice Address - Street 1:2230 N VETERANS BLVD STE 240
Practice Address - Street 2:
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852-6620
Practice Address - Country:US
Practice Address - Phone:830-773-7239
Practice Address - Fax:830-773-7239
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-22
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX97011176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife