Healthcare Provider Details

I. General information

NPI: 1235058751
Provider Name (Legal Business Name): LOURDES IYVONNE LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1116 SPIES DR
EAGLE PASS TX
78852-5543
US

IV. Provider business mailing address

1116 SPIES DR
EAGLE PASS TX
78852-5543
US

V. Phone/Fax

Practice location:
  • Phone: 830-498-1413
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: