1508050238 NPI number — LUIS ALFONSO LOPEZ, MD, PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508050238 NPI number — LUIS ALFONSO LOPEZ, MD, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LUIS ALFONSO LOPEZ, MD, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LITTLE BUDDIES PEDIATRIC CLINIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508050238
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/09/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20642 STONE OAK PARKWAY
Provider Second Line Business Mailing Address:
STE 105
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78258
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-650-0814
Provider Business Mailing Address Fax Number:
210-650-0926

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20642 STONE OAK PARKWAY
Provider Second Line Business Practice Location Address:
STE 105
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78258
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-650-0814
Provider Business Practice Location Address Fax Number:
210-650-0926
Provider Enumeration Date:
09/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LOPEZ
Authorized Official First Name:
LUIS
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
210-650-0814

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  K1530 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1732737-02 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 173273703 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1732737-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 173273704 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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