Provider Demographics
NPI:1063265429
Name:LOPEZ BELLO, JUSTO JOSE (SA-C)
Entity type:Individual
Prefix:
First Name:JUSTO
Middle Name:JOSE
Last Name:LOPEZ BELLO
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2425 SAGE RD APT 205
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77056-5026
Mailing Address - Country:US
Mailing Address - Phone:786-499-4577
Mailing Address - Fax:
Practice Address - Street 1:2425 SAGE RD APT 205
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77056-5026
Practice Address - Country:US
Practice Address - Phone:786-499-4577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21-266246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant