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NPI Code Detail

MEDICARE: MARIA CLARISA LOPEZ

MEDICARE: MARIA CLARISA LOPEZ
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1609493121
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIA CLARISA LOPEZ
Provider Business Mailing Address
First Line : 9314 RYDER DR
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78254-2000
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1035 BELVIDERE ST STE 123
Second Line :
City : EL PASO
State : TX
Zip : 79912-2433
Country : US
Telephone Number : 915-219-4222
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2020
Last Update Date : 06/30/2020

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Directions to “ MARIA CLARISA LOPEZ ” Practice Location

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