1710333620 NPI number — MICHELLE LOPEZ M.D.

Table of content: MICHELLE LOPEZ M.D. (NPI 1710333620)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710333620 NPI number — MICHELLE LOPEZ M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOPEZ
Provider First Name:
MICHELLE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1710333620
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 531968
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARLINGEN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78553-1968
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
833-887-4863
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
205 E TORONTO AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MCALLEN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78503-1209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
833-887-4863
Provider Business Practice Location Address Fax Number:
956-296-6857
Provider Enumeration Date:
05/10/2016

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: 207R00000X , with the licence number:  S1168 , 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: 3996282-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: H08LJ20301 . This is a "BCBS-TX" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".