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General NPI Number Information
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NPI Number | 1205103751
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Entity Type | Individual
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Provider Name | MARIELISA LOPEZ M.D.
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Gender | Female
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Dates
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Enumeration Date | 11/29/2011
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Last Update Date | 03/16/2020
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Provider Practice Location Address
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Address Line | 5151 HARRY HINES BOULEVARD CS6.104C
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City | DALLAS
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State | TX
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Zip | 75390-8860
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Country | US
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Telephone | 214-645-1711
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Fax |
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Provider Business Mailing Address
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Address Line | 5151 HARRY HINES BOULEVARD CS6.104C
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City | DALLAS
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State | TX
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Zip | 75390-8860
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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 |
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | Q9854
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License Number State | TX
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