Provider Demographics
NPI:1952474397
Name:LOPEZ, PAMELA (APRN-BC, CDE)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:APRN-BC, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:TX
Mailing Address - Zip Code:78589-3132
Mailing Address - Country:US
Mailing Address - Phone:956-789-0028
Mailing Address - Fax:
Practice Address - Street 1:1116 E 8TH ST STE 3
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-7288
Practice Address - Country:US
Practice Address - Phone:956-603-1555
Practice Address - Fax:956-800-6369
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX649282363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily