MEDICARE: MR. CARLOS JUNIOR LOPEZ LVN

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	164X00000X	Licensed Vocational Nurse	203074	TX

General Provider Information

NPI Number	:	1477613701
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CARLOS JUNIOR LOPEZ LVN

Provider Business Mailing Address
First Line	:	11025 VISTA DEL SOL DR APT 2256
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79935-4338
Country	:	US
Telephone Number	:	915-760-7122
Fax Number	:

Provider Business Practice Location Address
First Line	:	11525 VISTA DEL SOL DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-5629
Country	:	US
Telephone Number	:	915-855-3636
Fax Number	:

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

Provider Enumeration Date	:	12/08/2006
Last Update Date	:	07/08/2007

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