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General NPI Number Information
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NPI Number | 1174000806
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Entity Type | Individual
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Provider Name | RUBEN LOPEZ III
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Gender | Male
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Dates
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Enumeration Date | 07/25/2018
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Last Update Date | 07/25/2018
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Provider Practice Location Address
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Address Line | 18012 SAGO PALM DR STE 4
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City | PENITAS
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State | TX
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Zip | 78576-7392
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Country | US
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Telephone | 956-519-4242
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Fax | 956-999-8528
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Provider Business Mailing Address
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Address Line | PO BOX 796
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City | PENITAS
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State | TX
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Zip | 78576-0796
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Country | US
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Telephone | 956-583-8772
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number | 38196
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License Number State | TX
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