Provider Demographics
NPI:1477975431
Name:LOPEZ, OMAR DANIEL (CRNA, DNP)
Entity type:Individual
Prefix:DR
First Name:OMAR
Middle Name:DANIEL
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:CRNA, DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6046 LAGUNA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79932-4109
Mailing Address - Country:US
Mailing Address - Phone:915-329-7008
Mailing Address - Fax:
Practice Address - Street 1:6046 LAGUNA VISTA
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79932-6900
Practice Address - Country:US
Practice Address - Phone:915-329-7008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-10
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP125038367500000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program