Provider Demographics
NPI:1558863456
Name:LOPEZ, CINDY
Entity type:Individual
Prefix:
First Name:CINDY
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 1:700 E BRAVO BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:ROMA
Mailing Address - State:TX
Mailing Address - Zip Code:78584-5741
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:700 E BRAVO BLVD STE D
Practice Address - Street 2:
Practice Address - City:ROMA
Practice Address - State:TX
Practice Address - Zip Code:78584-5741
Practice Address - Country:US
Practice Address - Phone:956-849-1818
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
TX2048589225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant