1912227893 NPI number — DR. RAUL GUILLERMO LOPEZ VALLE MD

Table of content: DR. RAUL GUILLERMO LOPEZ VALLE MD (NPI 1912227893)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912227893 NPI number — DR. RAUL GUILLERMO LOPEZ VALLE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOPEZ VALLE
Provider First Name:
RAUL
Provider Middle Name:
GUILLERMO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LOPEZ VALLE
Provider Other First Name:
RAUL
Provider Other Middle Name:
GUILLERMO
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1912227893
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/22/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
900 GRANBERRY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUMBLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77338-4757
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-973-8049
Provider Business Mailing Address Fax Number:
281-570-2943

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 GRANBERRY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUMBLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77338-4757
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-973-8049
Provider Business Practice Location Address Fax Number:
281-570-2943
Provider Enumeration Date:
06/02/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  P8153 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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