Healthcare Provider Details

I. General information

NPI: 1194567560
Provider Name (Legal Business Name): ROXANA LOPEZ FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2024
Last Update Date: 06/07/2024
Certification Date: 06/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12011 STATE HIGHWAY 151 STE 202
SAN ANTONIO TX
78251-1233
US

IV. Provider business mailing address

215 N SAN SABA STE 301
SAN ANTONIO TX
78207-3164
US

V. Phone/Fax

Practice location:
  • Phone: 210-265-8155
  • Fax: 210-477-2750
Mailing address:
  • Phone: 210-212-8622
  • Fax: 210-212-9197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1144234
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: