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NPI Code Detail

MEDICARE: NIDIA LOPEZ PA

MEDICARE: NIDIA LOPEZ PA
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
1363A00000XPhysician AssistantPA04792TX

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P00889868OTHERTXRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1809N07OTHERTXBCBS
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5830N22OTHERTXBCBS

General Provider Information

NPI Number : 1770549750
Entity Type Code : Individual
Provider Name (Legal Business Name) : NIDIA LOPEZ PA
Provider Business Mailing Address
First Line : PO BOX 911230
Second Line :
City : DALLAS
State : TX
Zip : 75391-1230
Country : US
Telephone Number : 972-997-8000
Fax Number : 972-234-0819
Provider Business Practice Location Address
First Line : 1901 GRANDVIEW AVE
Second Line :
City : EL PASO
State : TX
Zip : 79902-5113
Country : US
Telephone Number : 915-544-6750
Fax Number : 915-532-4259
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/26/2006
Last Update Date : 12/12/2019

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Directions to “ NIDIA LOPEZ PA” Practice Location

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