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General NPI Number Information
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NPI Number | 1780565366
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Entity Type | Individual
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Provider Name | MAX LOPEZ
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Gender | Male
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Dates
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Enumeration Date | 09/10/2025
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Last Update Date | 09/10/2025
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Provider Practice Location Address
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Address Line | 101 PINE MANOR DR
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City | CONROE
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State | TX
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Zip | 77385-9059
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Country | US
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Telephone | 281-364-7889
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Fax |
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Provider Business Mailing Address
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Address Line | 4120 AMADOR CT
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City | FLOWER MOUND
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State | TX
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Zip | 75022-2947
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Country | US
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Telephone | 214-934-6497
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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