MEDICARE: CESAR LOPEZ HEALTH EDUCATOR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171400000X	Health & Wellness Coach

General Provider Information

NPI Number	:	1083369508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CESAR LOPEZ HEALTH EDUCATOR

Provider Business Mailing Address
First Line	:	9601 PICKWICK TRL
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76131-1488
Country	:	US
Telephone Number	:	817-914-2159
Fax Number	:

Provider Business Practice Location Address
First Line	:	9601 PICKWICK TRL
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76131-1488
Country	:	US
Telephone Number	:	817-914-2159
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2022
Last Update Date	:	02/14/2022

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