Provider Demographics
NPI:1255388112
Name:LOPEZ-TERRADA, DOLORES HILDEGARD (MD PHD)
Entity type:Individual
Prefix:
First Name:DOLORES
Middle Name:HILDEGARD
Last Name:LOPEZ-TERRADA
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 741169
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77274-1169
Mailing Address - Country:US
Mailing Address - Phone:832-824-1866
Mailing Address - Fax:832-825-1032
Practice Address - Street 1:6621 FANNIN STREET
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2399
Practice Address - Country:US
Practice Address - Phone:832-824-1866
Practice Address - Fax:832-825-1032
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9336207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H12382Medicare UPIN
TX8038J1Medicare PIN