Healthcare Provider Details

I. General information

NPI: 1457186322
Provider Name (Legal Business Name): CRISTAL MEJIA LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2024
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 N MCCOLL RD
MCALLEN TX
78501-9335
US

IV. Provider business mailing address

403 W CHEYENNE AVE
PHARR TX
78577-9677
US

V. Phone/Fax

Practice location:
  • Phone: 956-588-6660
  • Fax:
Mailing address:
  • Phone: 956-588-6660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number106221
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: