Provider Demographics
NPI:1790333482
Name:LOPEZ, MAYRA F (RD/LD)
Entity Type:Individual
Prefix:
First Name:MAYRA
Middle Name:F
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:RD/LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6506
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78502-6506
Mailing Address - Country:US
Mailing Address - Phone:956-784-2703
Mailing Address - Fax:
Practice Address - Street 1:8605 N 19TH ST
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-6173
Practice Address - Country:US
Practice Address - Phone:956-784-2703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT07592133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered