MEDICARE: SERGIO J. LOPEZ NP-C, MSN,RNFA-CNOR

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	163W00000X	Registered Nurse	654368	TX
2	163WR0006X	Registered Nurse First Assistant	654368	TX
3	363LP2300X	Primary Care Nurse Practitioner	AP124274	TX

General Provider Information

NPI Number	:	1376573907
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SERGIO J. LOPEZ NP-C, MSN,RNFA-CNOR

Provider Business Mailing Address
First Line	:	7535 SUMMERDALE DR
Second Line	:
City	:	ROSENBERG
State	:	TX
Zip	:	77469-4629
Country	:	US
Telephone Number	:	956-451-2568
Fax Number	:	956-387-0917

Provider Business Practice Location Address
First Line	:	7535 SUMMERDALE DR
Second Line	:
City	:	ROSENBERG
State	:	TX
Zip	:	77469-4629
Country	:	US
Telephone Number	:	956-451-2568
Fax Number	:	956-387-0917

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

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	10/30/2014

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