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NPI Code Detail

MEDICARE: JUANITA C LOPEZ PA

MEDICARE: JUANITA C LOPEZ PA
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
1174400000XSpecialistPA03700TX
2363A00000XPhysician Assistant

General Provider Information

NPI Number : 1194855817
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUANITA C LOPEZ PA
Provider Business Mailing Address
First Line : 720 GOLDER AVE
Second Line :
City : ODESSA
State : TX
Zip : 79761-4442
Country : US
Telephone Number : 432-337-3117
Fax Number : 432-337-3448
Provider Business Practice Location Address
First Line : 720 GOLDER AVE
Second Line :
City : ODESSA
State : TX
Zip : 79761-4442
Country : US
Telephone Number : 432-337-3117
Fax Number : 432-337-3448
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/06/2007
Last Update Date : 01/02/2014

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Directions to “ JUANITA C LOPEZ PA” Practice Location

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