Provider Demographics
NPI:1952063646
Name:LOPEZ, ANA MARIE
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:MARIE
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 1:4805 N 47TH ST
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-4865
Mailing Address - Country:US
Mailing Address - Phone:956-784-0250
Mailing Address - Fax:
Practice Address - Street 1:5506 S JACKSON RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-9902
Practice Address - Country:US
Practice Address - Phone:956-661-0066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-10
Last Update Date:2021-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1056661363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily