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General NPI Number Information
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NPI Number | 1104599679
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Entity Type | Organization
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Legal Business Name | ROBERTO MAURO LOPEZ MD PA
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Dates
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Enumeration Date | 07/29/2021
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Last Update Date | 07/29/2021
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Provider Practice Location Address
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Address Line | 1400 W GRIFFIN PKWY SUITE 1
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City | MISSION
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State | TX
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Zip | 78572
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Country | US
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Telephone | 956-563-7046
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Fax |
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Provider Business Mailing Address
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Address Line | 2509 SANDSTONE DR
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City | MISSION
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State | TX
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Zip | 78574-2774
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | SRIKANTH NANGAVARAM
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Credential |
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Telephone | 956-215-6010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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