Provider Demographics
NPI:1619548104
Name:ROBERTO MURO LOPEZ MD PA
Entity Type:Organization
Organization Name:ROBERTO MURO LOPEZ MD PA
Other - Org Name:LAS FUENTES MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:MAURO
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-997-0106
Mailing Address - Street 1:1400 W GRIFFIN PARK
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-0001
Mailing Address - Country:US
Mailing Address - Phone:956-997-0106
Mailing Address - Fax:956-997-0105
Practice Address - Street 1:1400 W GRIFFIN PARK
Practice Address - Street 2:SUITE 1
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-0001
Practice Address - Country:US
Practice Address - Phone:956-997-0106
Practice Address - Fax:956-997-0105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-06
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty