Provider Demographics
NPI:1942767744
Name:LOPEZ, JUNIPER
Entity Type:Individual
Prefix:
First Name:JUNIPER
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1583 JACOBS FOREST DR
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77384-3409
Mailing Address - Country:US
Mailing Address - Phone:832-453-3198
Mailing Address - Fax:
Practice Address - Street 1:1583 JACOBS FOREST DR
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77384-3409
Practice Address - Country:US
Practice Address - Phone:832-453-3198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-27
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver