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General NPI Number Information
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NPI Number | 1497199913
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Entity Type | Organization
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Legal Business Name | SALVADOR LOPEZ JR PHD PC
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Dates
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Enumeration Date | 04/26/2013
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Last Update Date | 07/28/2015
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Provider Practice Location Address
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Address Line | 7201 BROADWAY ST SUITE 218
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City | SAN ANTONIO
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State | TX
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Zip | 78209-3773
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Country | US
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Telephone | 210-413-9779
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Fax | 210-239-6868
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Provider Business Mailing Address
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Address Line | 7201 BROADWAY ST SUITE 218
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City | SAN ANTONIO
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State | TX
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Zip | 78209-3773
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Country | US
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Telephone | 210-413-9779
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Fax | 210-239-6868
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Authorized Official
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Title or Position | DIRECTOR
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Name | SALVADOR LOPEZ JR.
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Credential | PHD
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Telephone | 210-413-9779
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 22593
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License Number State | TX
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