Provider Demographics
NPI:1124067749
Name:LOPEZ, JUAN A (RN)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:A
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3600
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78044-3600
Mailing Address - Country:US
Mailing Address - Phone:956-724-3108
Mailing Address - Fax:956-724-3613
Practice Address - Street 1:1710 E SAUNDERS ST
Practice Address - Street 2:STE B675
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-5443
Practice Address - Country:US
Practice Address - Phone:956-724-3108
Practice Address - Fax:956-724-3613
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX0374930363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8B6058Medicare ID - Type Unspecified