Healthcare Provider Details

I. General information

NPI: 1427792324
Provider Name (Legal Business Name): KATRINA M LOPEZ DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2022
Last Update Date: 04/10/2023
Certification Date: 04/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7703 FLOYD CURL DR FL 6
SAN ANTONIO TX
78229-3901
US

IV. Provider business mailing address

3731 CHESTER AVE
EL PASO TX
79903-1704
US

V. Phone/Fax

Practice location:
  • Phone: 210-450-6470
  • Fax: 210-567-5354
Mailing address:
  • Phone: 224-542-8171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberBP10082561
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: