Provider Demographics
NPI:1205158193
Name:LOPEZ, MARY NAOMI
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:NAOMI
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 1:3006 CARLA DR.
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75088
Mailing Address - Country:US
Mailing Address - Phone:972-475-6327
Mailing Address - Fax:972-463-9176
Practice Address - Street 1:3006 CARLA DR.
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75088
Practice Address - Country:US
Practice Address - Phone:972-475-6327
Practice Address - Fax:972-463-9176
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-19
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies