Healthcare Provider Details

I. General information

NPI: 1831228121
Provider Name (Legal Business Name): MIGUEL ANGEL LOPEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 02/06/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11212 HIGHWAY 151
SAN ANTONIO TX
78251-4498
US

IV. Provider business mailing address

11212 HIGHWAY 151
SAN ANTONIO TX
78251-4498
US

V. Phone/Fax

Practice location:
  • Phone: 210-450-9900
  • Fax:
Mailing address:
  • Phone: 210-450-9900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberT4203
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: