Provider Demographics
NPI:1922687839
Name:QUICENO LOPEZ, JULIAN ESTEBAN (FNP)
Entity Type:Individual
Prefix:
First Name:JULIAN
Middle Name:ESTEBAN
Last Name:QUICENO LOPEZ
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2108 CHURCH ST APT 303
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77550-2095
Mailing Address - Country:US
Mailing Address - Phone:713-505-8049
Mailing Address - Fax:
Practice Address - Street 1:2817 POST OFFICE ST
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77550-1728
Practice Address - Country:US
Practice Address - Phone:409-765-2237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX915910163W00000X
TX1034117363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse