Provider Demographics
NPI:1760418867
Name:LOPEZ, DAVID NARANJO (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:NARANJO
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4910 GOLDEN QUAIL STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1769
Mailing Address - Country:US
Mailing Address - Phone:210-615-8495
Mailing Address - Fax:210-615-8747
Practice Address - Street 1:4910 GOLDEN QUAIL STE 100
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1769
Practice Address - Country:US
Practice Address - Phone:210-615-8495
Practice Address - Fax:210-615-8747
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7570207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8B5636OtherMEDICARE
TX138822514Medicaid
TX8B5636OtherMEDICARE