Provider Demographics
NPI:1104405653
Name:LOPEZ, LINO JR (NP-C)
Entity type:Individual
Prefix:
First Name:LINO
Middle Name:
Last Name:LOPEZ
Suffix:JR
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2044 S CLACK ST APT 544
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-1395
Mailing Address - Country:US
Mailing Address - Phone:361-687-5108
Mailing Address - Fax:
Practice Address - Street 1:4444 CORONA DR STE 131
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4321
Practice Address - Country:US
Practice Address - Phone:361-645-7999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-02
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1031692363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner