Healthcare Provider Details

I. General information

NPI: 1033308572
Provider Name (Legal Business Name): MRS. SANDRA L. LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2007
Last Update Date: 10/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12253 DELACROIX DR
EL PASO TX
79936-0248
US

IV. Provider business mailing address

11531 JACQUELIN ANN CT
EL PASO TX
79936-3916
US

V. Phone/Fax

Practice location:
  • Phone: 915-525-3269
  • Fax:
Mailing address:
  • Phone: 915-857-3386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number32918
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: