MEDICARE: MS. DORA VENESSA LOPEZ I FNP

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	363LP2300X	Primary Care Nurse Practitioner	F11200601	TX

General Provider Information

NPI Number	:	1295321230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DORA VENESSA LOPEZ I FNP

Provider Business Mailing Address
First Line	:	14470 HORIZON BLVD
Second Line	:
City	:	HORIZON CITY
State	:	TX
Zip	:	79928-7695
Country	:	US
Telephone Number	:	915-852-3225
Fax Number	:

Provider Business Practice Location Address
First Line	:	13800 EASTLAKE BLVD STE 400
Second Line	:
City	:	HORIZON CITY
State	:	TX
Zip	:	79928-7389
Country	:	US
Telephone Number	:	915-577-1134
Fax Number	:

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

Provider Enumeration Date	:	12/14/2020
Last Update Date	:	08/29/2025

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