MEDICARE: INGRID GONZALEZ 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
1	363LF0000X	Family Nurse Practitioner	1051840	TX

General Provider Information

NPI Number	:	1619812096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	INGRID GONZALEZ LOPEZ

Provider Business Mailing Address
First Line	:	17711 BARKER BLUFF LN
Second Line	:
City	:	CYPRESS
State	:	TX
Zip	:	77433-2270
Country	:	US
Telephone Number	:	346-204-2151
Fax Number	:

Provider Business Practice Location Address
First Line	:	15840 FM 529 RD STE 102
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77095-5285
Country	:	US
Telephone Number	:	832-390-0955
Fax Number	:	833-390-0956

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

Provider Enumeration Date	:	04/21/2026
Last Update Date	:	04/21/2026

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Directions to “ INGRID GONZALEZ LOPEZ ” Practice Location

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