Provider Demographics
NPI:1124480751
Name:LOPEZ-BRISENO, MARIA CLARISSA (NP)
Entity type:Individual
Prefix:MS
First Name:MARIA
Middle Name:CLARISSA
Last Name:LOPEZ-BRISENO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5714 SPOHN DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-4116
Mailing Address - Country:US
Mailing Address - Phone:361-906-0900
Mailing Address - Fax:361-906-0939
Practice Address - Street 1:5714 SPOHN DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-4116
Practice Address - Country:US
Practice Address - Phone:361-906-0900
Practice Address - Fax:361-906-0939
Is Sole Proprietor?:No
Enumeration Date:2016-03-23
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP130358363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX486510YLPSOtherWELLMED PTAN
TX356424701Medicaid