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NPI Code Detail

MEDICARE: SUSAN MARIE LOPEZ RD

MEDICARE: SUSAN MARIE LOPEZ RD
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
1133V00000XRegistered DietitianDX6355MD
2133V00000XRegistered DietitianDT84625TX

General Provider Information

NPI Number : 1588219059
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN MARIE LOPEZ RD
Provider Business Mailing Address
First Line : 13715 MIDFIELD GLEN CT
Second Line :
City : HOUSTON
State : TX
Zip : 77059-3506
Country : US
Telephone Number : 281-832-9811
Fax Number :
Provider Business Practice Location Address
First Line : 4301 GARDEN CITY DR STE 304
Second Line :
City : HYATTSVILLE
State : MD
Zip : 20785-6105
Country : US
Telephone Number : 301-235-0600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2019
Last Update Date : 12/01/2023

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