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General NPI Number Information
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NPI Number | 1407736481
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Entity Type | Individual
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Provider Name | JESUS ELEAZAR LOPEZ
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Gender | Male
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Dates
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Enumeration Date | 09/02/2025
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 5750 PINELAND DR
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City | DALLAS
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State | TX
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Zip | 75231-5300
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Country | US
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Telephone | 214-221-0855
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Fax |
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Provider Business Mailing Address
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Address Line | 2275 HAWES AVE APT 519
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City | DALLAS
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State | TX
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Zip | 75235-3839
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Country | US
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Telephone | 281-799-9355
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 116601
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License Number State | TX
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