Provider Demographics
NPI:1730112236
Name:RODRIGUEZ-LOPEZ, ANA LISA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANA
Middle Name:LISA
Last Name:RODRIGUEZ-LOPEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4060 SANDSHELL DR
Mailing Address - Street 2:CONCENTRA URGENT CARE
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76137-2422
Mailing Address - Country:US
Mailing Address - Phone:817-306-9777
Mailing Address - Fax:
Practice Address - Street 1:4060 SANDSHELL DR
Practice Address - Street 2:CONCENTRA URGENT CARE
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76137-2422
Practice Address - Country:US
Practice Address - Phone:817-306-9777
Practice Address - Fax:817-306-9780
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM200190207Q00000X
TXP7699207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMG9292Medicaid
NMG9292Medicaid
NMH43231Medicare UPIN