Provider Demographics
NPI:1649422171
Name:LOPEZ, EDITH
Entity type:Individual
Prefix:
First Name:EDITH
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 1:205 E EXPRESSWAY 83
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-6547
Mailing Address - Country:US
Mailing Address - Phone:956-283-1399
Mailing Address - Fax:956-283-1359
Practice Address - Street 1:205 E EXPRESSWAY 83
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-6547
Practice Address - Country:US
Practice Address - Phone:956-283-1399
Practice Address - Fax:956-283-1359
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-15
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0106920332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0106920OtherTEXAS HEALTH DEPARTMENT
SC6312350001Medicare NSC