Provider Demographics
NPI:1821275470
Name:LOPEZ-CANINO, ANTONIO RAFAEL (MD)
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:RAFAEL
Last Name:LOPEZ-CANINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 EAST NINTH STREET
Mailing Address - Street 2:NORTH TEXAS VETERANS HEALTHCARE
Mailing Address - City:BONHAM
Mailing Address - State:TX
Mailing Address - Zip Code:75418
Mailing Address - Country:US
Mailing Address - Phone:903-583-6241
Mailing Address - Fax:
Practice Address - Street 1:1201 EAST NINTH STREET
Practice Address - Street 2:NORTH TEXAS VETERANS HEALTHCARE
Practice Address - City:BONHAM
Practice Address - State:TX
Practice Address - Zip Code:75418
Practice Address - Country:US
Practice Address - Phone:903-583-6241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-25
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2420172084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry