Healthcare Provider Details

I. General information

NPI: 1447300066
Provider Name (Legal Business Name): JULIO A LOPEZ & ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 07/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 SOUTH BROADWAY
ELSA TX
78543
US

IV. Provider business mailing address

PO BOX 356
ELSA TX
78543-0356
US

V. Phone/Fax

Practice location:
  • Phone: 956-262-1304
  • Fax: 956-262-3929
Mailing address:
  • Phone: 956-262-1304
  • Fax: 956-262-3929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License NumberE6964
License Number StateTX

VIII. Authorized Official

Name: DR. JULIO A LOPEZ
Title or Position: MEDICAL DOCTOR
Credential: MD
Phone: 956-262-1304