Provider Demographics
NPI:1255876942
Name:LOPEZ, CESAR
Entity type:Individual
Prefix:
First Name:CESAR
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 S AIRPORT DR
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-6600
Mailing Address - Country:US
Mailing Address - Phone:956-969-2609
Mailing Address - Fax:956-973-0413
Practice Address - Street 1:1010 S AIRPORT DR
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-6600
Practice Address - Country:US
Practice Address - Phone:956-969-2609
Practice Address - Fax:956-973-0413
Is Sole Proprietor?:No
Enumeration Date:2017-01-04
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP132634363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily