MEDICARE: JOANNA 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	373H00000X	Day Training/Habilitation Specialist

General Provider Information

NPI Number	:	1790139764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANNA LOPEZ

Provider Business Mailing Address
First Line	:	10305 SHANNON PL
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79925-1620
Country	:	US
Telephone Number	:	915-383-0908
Fax Number	:

Provider Business Practice Location Address
First Line	:	10305 SHANNON PL
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79925-1620
Country	:	US
Telephone Number	:	915-383-0908
Fax Number	:

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

Provider Enumeration Date	:	04/15/2016
Last Update Date	:	04/15/2016

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