Provider Demographics
NPI:1255953329
Name:LOPEZ, ANDREA AMY (RD, LD)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:AMY
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6318 WINDMILL CIR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-2425
Mailing Address - Country:US
Mailing Address - Phone:469-585-0831
Mailing Address - Fax:
Practice Address - Street 1:UT SOUTHWESTERN MEDICAL CENTER FRISCO
Practice Address - Street 2:12500 DALLAS PKWY, 2ND FLOOR
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-9371
Practice Address - Country:US
Practice Address - Phone:469-604-9259
Practice Address - Fax:469-604-9001
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-12
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT85260133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered