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NPI Code Detail

MEDICARE: CHRISTY JEAN LOPEZ

MEDICARE: CHRISTY JEAN 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
1172A00000XDriver06021561TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
13732725OTHERTXFMCSA

General Provider Information

NPI Number : 1780349456
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTY JEAN LOPEZ
Provider Business Mailing Address
First Line : 701 TILLERY ST STE 12
Second Line :
City : AUSTIN
State : TX
Zip : 78702-3751
Country : US
Telephone Number : 877-711-6559
Fax Number :
Provider Business Practice Location Address
First Line : 701 TILLERY ST STE 12
Second Line :
City : AUSTIN
State : TX
Zip : 78702-3751
Country : US
Telephone Number : 877-711-6559
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/08/2021
Last Update Date : 11/08/2021

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Directions to “ CHRISTY JEAN LOPEZ ” Practice Location

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