Healthcare Provider Details

I. General information

NPI: 1982348090
Provider Name (Legal Business Name): FABIANA SILVA LOPES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: FABIANA CASTRO PORTO SILVA LOPES MD

II. Dates (important events)

Enumeration Date: 04/25/2022
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N LAKELINE BLVD STE A
CEDAR PARK TX
78613-2089
US

IV. Provider business mailing address

200 N LAKELINE BLVD STE A
CEDAR PARK TX
78613-2089
US

V. Phone/Fax

Practice location:
  • Phone: 512-617-3000
  • Fax: 512-309-7034
Mailing address:
  • Phone: 512-617-3000
  • Fax: 512-309-7034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberW1756
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: