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General NPI Number Information
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NPI Number | 1790403020
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Entity Type | Individual
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Provider Name | MISS REANA LOPEZ
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Gender | Female
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Dates
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Enumeration Date | 08/22/2022
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Last Update Date | 12/06/2024
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Provider Practice Location Address
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Address Line | 828 MYER LN
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City | KERMIT
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State | TX
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Zip | 79745-4634
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Country | US
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Telephone | 432-586-2040
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Fax |
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Provider Business Mailing Address
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Address Line | 2818 W LOOP 250 N APT J304
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City | MIDLAND
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State | TX
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Zip | 79705-3362
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Country | US
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Telephone | 432-250-0585
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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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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA18462
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License Number State | TX
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