Provider Demographics
NPI:1770950693
Name:LOPEZ, ANA
Entity type:Individual
Prefix:DR
First Name:ANA
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 1:16601 BLANCO RD
Mailing Address - Street 2:205
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-1914
Mailing Address - Country:US
Mailing Address - Phone:210-468-1734
Mailing Address - Fax:
Practice Address - Street 1:16601 BLANCO RD
Practice Address - Street 2:205
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-1914
Practice Address - Country:US
Practice Address - Phone:210-468-1734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-26
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37097103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist