Provider Demographics
NPI:1720717879
Name:LOPEZ, JONATHAN (PA)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8634 MAGNOLIA FOREST DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-6957
Mailing Address - Country:US
Mailing Address - Phone:281-744-3354
Mailing Address - Fax:
Practice Address - Street 1:8634 MAGNOLIA FOREST DR
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-6957
Practice Address - Country:US
Practice Address - Phone:281-744-3354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant