Healthcare Provider Details

I. General information

NPI: 1598632432
Provider Name (Legal Business Name): ANA LOPEZ CARDONA
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2025
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 TRINITY ST
AUSTIN TX
78712-1765
US

IV. Provider business mailing address

340 HORSEMINT LN
GEORGETOWN TX
78633-2622
US

V. Phone/Fax

Practice location:
  • Phone: 512-324-7831
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0100X
TaxonomyGastroenterology Registered Nurse
License Number987181
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: