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General NPI Number Information
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NPI Number | 1790713717
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Entity Type | Organization
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Legal Business Name | LOPEZ ANESTHESIA PA
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Dates
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Enumeration Date | 06/29/2006
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Last Update Date | 12/27/2011
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Provider Practice Location Address
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Address Line | 10700 MCPHERSON AVE
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City | LAREDO
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State | TX
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Zip | 78045-6268
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Country | US
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Telephone | 956-763-4682
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Fax |
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Provider Business Mailing Address
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Address Line | P O BOX 678690
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City | DALLAS
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State | TX
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Zip | 75267-8690
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Country | US
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Telephone | 972-758-3598
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. VICTOR LOPEZ
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Credential | MD
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Telephone | 956-763-4682
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number |
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License Number State |
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