1316272735 NPI number — MRS. HELEN ANNE BENNETT-LOPEZ MPA-LCDC

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 1316272735 NPI number — MRS. HELEN ANNE BENNETT-LOPEZ MPA-LCDC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BENNETT-LOPEZ
Provider First Name:
HELEN
Provider Middle Name:
ANNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MPA-LCDC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1316272735
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/05/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9459 VALLEY DL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78250-3901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-464-3767
Provider Business Mailing Address Fax Number:
210-271-9414

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3700 FREDERICKSBURG RD
Provider Second Line Business Practice Location Address:
SUITE 137
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78201-3269
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-265-1133
Provider Business Practice Location Address Fax Number:
210-259-8528
Provider Enumeration Date:
10/04/2009

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: 101YA0400X , with the licence number:  8378 , 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)

  • Identifier: 8378 . This is a "DSHS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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