Provider Demographics
NPI:1790931673
Name:RENE I LOPEZ JR M.D. P.A.
Entity Type:Organization
Organization Name:RENE I LOPEZ JR M.D. P.A.
Other - Org Name:CLINICA LAS AMERICAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:713-973-8292
Mailing Address - Street 1:8635 LONG POINT RD STE B
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-3001
Mailing Address - Country:US
Mailing Address - Phone:713-973-8292
Mailing Address - Fax:713-973-0841
Practice Address - Street 1:8635 LONG POINT RD STE B
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-3001
Practice Address - Country:US
Practice Address - Phone:713-973-8292
Practice Address - Fax:713-973-0841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-12
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8135207Q00000X
207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1356555189OtherNPI
TX197990803Medicaid
TX199790803Medicaid