Provider Demographics
NPI:1811260748
Name:LOPEZ SANTANA, MARYURI ENID (MA)
Entity type:Individual
Prefix:MISS
First Name:MARYURI
Middle Name:ENID
Last Name:LOPEZ SANTANA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12055 SABO RD
Mailing Address - Street 2:432
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77089-6282
Mailing Address - Country:US
Mailing Address - Phone:832-208-2051
Mailing Address - Fax:
Practice Address - Street 1:12021 PIONEERS WAY APT 1118
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832-2802
Practice Address - Country:US
Practice Address - Phone:713-894-1614
Practice Address - Fax:407-264-6421
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-23
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35884261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech