Provider Demographics
NPI:1184916546
Name:LOPEZ, JESSICA A (MD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:A
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:ANNE
Other - Last Name:HETHERINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4204 GARDENDALE ST
Mailing Address - Street 2:STE 312
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3132
Mailing Address - Country:US
Mailing Address - Phone:917-439-6971
Mailing Address - Fax:
Practice Address - Street 1:4204 GARDENDALE ST
Practice Address - Street 2:STE 312
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3132
Practice Address - Country:US
Practice Address - Phone:917-439-6971
Practice Address - Fax:210-614-1722
Is Sole Proprietor?:No
Enumeration Date:2011-05-04
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ4183207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine