Provider Demographics
NPI:1790839892
Name:MARIA I LOPEZ
Entity Type:Organization
Organization Name:MARIA I LOPEZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:ISABEL
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-639-2560
Mailing Address - Street 1:4618 MANITOU
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78228-1834
Mailing Address - Country:US
Mailing Address - Phone:210-436-6885
Mailing Address - Fax:210-431-7884
Practice Address - Street 1:4618 MANITOU
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-1834
Practice Address - Country:US
Practice Address - Phone:210-436-6885
Practice Address - Fax:210-431-7884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX117713385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care