Healthcare Provider Details

I. General information

NPI: 1013789338
Provider Name (Legal Business Name): ARCELIA CERECITA LOPEZ NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2023
Last Update Date: 10/30/2023
Certification Date: 10/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11680 PEBBLE HILLS BLVD # 107-109
EL PASO TX
79936-1090
US

IV. Provider business mailing address

11680 PEBBLE HILLS BLVD STE 107-109
EL PASO TX
79936-1090
US

V. Phone/Fax

Practice location:
  • Phone: 915-219-9434
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number1138726
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: