Provider Demographics
NPI:1295237188
Name:LOPEZ, LAURA
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
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 1:104 W ELM ST
Mailing Address - Street 2:
Mailing Address - City:GUSTINE
Mailing Address - State:TX
Mailing Address - Zip Code:76455-2500
Mailing Address - Country:US
Mailing Address - Phone:325-667-1410
Mailing Address - Fax:325-667-1410
Practice Address - Street 1:104 W ELM ST
Practice Address - Street 2:
Practice Address - City:GUSTINE
Practice Address - State:TX
Practice Address - Zip Code:76455-2500
Practice Address - Country:US
Practice Address - Phone:325-330-0456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-06
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant