Provider Demographics
NPI:1154911378
Name:LOPEZ, CAITLYN NICOLE
Entity type:Individual
Prefix:
First Name:CAITLYN
Middle Name:NICOLE
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6301 S STADIUM LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-1057
Mailing Address - Country:US
Mailing Address - Phone:281-237-6647
Mailing Address - Fax:281-644-1846
Practice Address - Street 1:6301 S STADIUM LN
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-1057
Practice Address - Country:US
Practice Address - Phone:281-237-6647
Practice Address - Fax:281-644-1846
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX21-0035OtherTEXAS EARLY CHILDHOOD INTERVENTION