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General NPI Number Information
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NPI Number | 1235023516
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Entity Type | Individual
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Provider Name | ODALIZ IVETTE LOPEZ
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Gender | Female
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Dates
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Enumeration Date | 06/03/2025
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Last Update Date | 06/03/2025
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Provider Practice Location Address
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Address Line | 5430 FREDERICKSBURG RD
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City | SAN ANTONIO
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State | TX
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Zip | 78229-3539
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Country | US
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Telephone | 210-614-5539
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Fax |
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Provider Business Mailing Address
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Address Line | 10130 DAPPLE COLT
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City | SAN ANTONIO
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State | TX
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Zip | 78254-2746
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Country | US
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Telephone | 210-218-8480
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 1169650
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License Number State | TX
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