Healthcare Provider Details

I. General information

NPI: 1285550772
Provider Name (Legal Business Name): CHRISTEN MANUEL LOPEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: KRIS LOPEZ

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

829 N CEYLON ST
EAGLE PASS TX
78852-6858
US

IV. Provider business mailing address

829 N CEYLON ST
EAGLE PASS TX
78852-6858
US

V. Phone/Fax

Practice location:
  • Phone: 830-421-6201
  • Fax:
Mailing address:
  • Phone: 830-421-6201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberBACB1617674
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: