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General NPI Number Information
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NPI Number | 1790839892
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Entity Type | Organization
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Legal Business Name | MARIA I LOPEZ
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 06/17/2008
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Provider Practice Location Address
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Address Line | 4618 MANITOU
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City | SAN ANTONIO
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State | TX
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Zip | 78228-1834
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Country | US
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Telephone | 210-436-6885
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Fax | 210-431-7884
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Provider Business Mailing Address
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Address Line | 4618 MANITOU
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City | SAN ANTONIO
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State | TX
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Zip | 78228-1834
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Country | US
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Telephone | 210-436-6885
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Fax | 210-431-7884
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Authorized Official
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Title or Position | OWNER
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Name | MISS MARIA ISABEL LOPEZ
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Credential |
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Telephone | 210-639-2560
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number | 117713
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License Number State | TX
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