Provider Demographics
NPI:1265142509
Name:LOPEZ, ROCIO FERNANDA (LAC)
Entity type:Individual
Prefix:
First Name:ROCIO
Middle Name:FERNANDA
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4572 NEW MEXICO WAY
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-4133
Mailing Address - Country:US
Mailing Address - Phone:956-266-4250
Mailing Address - Fax:
Practice Address - Street 1:30 PROVIDENCIA CT STE 2
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-7433
Practice Address - Country:US
Practice Address - Phone:956-266-4250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01912171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist