MEDICARE: MIGDALIA LOPEZ GONZALES 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	363LF0000X	Family Nurse Practitioner	447873	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376655316
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIGDALIA LOPEZ GONZALES FNP

Provider Business Mailing Address
First Line	:	1400 N IH 35
Second Line	:	STE. 2.230
City	:	AUSTIN
State	:	TX
Zip	:	78701-1926
Country	:	US
Telephone Number	:	512-324-8235
Fax Number	:	512-324-8223

Provider Business Practice Location Address
First Line	:	1400 N IH 35
Second Line	:	STE. 2.230
City	:	AUSTIN
State	:	TX
Zip	:	78701-1926
Country	:	US
Telephone Number	:	512-324-8235
Fax Number	:	512-324-8223

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	02/08/2022

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