MEDICARE: BENJAMIN LOPEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP131445	TX

General Provider Information

NPI Number	:	1124571484
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJAMIN LOPEZ

Provider Business Mailing Address
First Line	:	222 LAS COLINAS BLVD W
Second Line	:	SUITE 2000
City	:	IRVING
State	:	TX
Zip	:	75039-5421
Country	:	US
Telephone Number	:	972-957-3000
Fax Number	:

Provider Business Practice Location Address
First Line	:	10058 LONG POINT RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77055-4002
Country	:	US
Telephone Number	:	832-380-3980
Fax Number	:	832-380-3985

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2016
Last Update Date	:	08/03/2016

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Directions to “ BENJAMIN LOPEZ ” Practice Location

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