Provider Demographics
NPI:1760866180
Name:LOPEZ, TAMMY
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 N O CONNOR RD
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-5681
Mailing Address - Country:US
Mailing Address - Phone:806-799-8950
Mailing Address - Fax:806-799-8939
Practice Address - Street 1:5303 50TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79414-1817
Practice Address - Country:US
Practice Address - Phone:806-799-8950
Practice Address - Fax:806-799-8939
Is Sole Proprietor?:No
Enumeration Date:2015-07-15
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80703237600000X
COAUD0001060231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80703OtherSTATE LICENSE
COAUD.0001060OtherSTATE LICENSE
NMAUD6443OtherSTATE LICENSE