Provider Demographics
NPI:1760661250
Name:LOPEZ, MARIA O (CRT)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:O
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:CRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1431 EVERGREEN AVE
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-6226
Mailing Address - Country:US
Mailing Address - Phone:956-279-1638
Mailing Address - Fax:
Practice Address - Street 1:1431 EVERGREEN AVE
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-6226
Practice Address - Country:US
Practice Address - Phone:956-279-1638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51099227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX51099OtherTEXAS STATE BOARD