Healthcare Provider Details

I. General information

NPI: 1427293919
Provider Name (Legal Business Name): REYNALDO A. LOPEZ LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2008
Last Update Date: 01/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 S ZARZAMORA ST
SAN ANTONIO TX
78207-5209
US

IV. Provider business mailing address

PO BOX 87
SAN ANTONIO TX
78291-0087
US

V. Phone/Fax

Practice location:
  • Phone: 210-358-7527
  • Fax: 210-358-7515
Mailing address:
  • Phone: 210-358-9174
  • Fax: 210-358-5753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: