Provider Demographics
NPI:1336803089
Name:LOPEZ, MAURO ALEJANDRO
Entity type:Individual
Prefix:
First Name:MAURO
Middle Name:ALEJANDRO
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 LAS MITRAS LN
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-5682
Mailing Address - Country:US
Mailing Address - Phone:956-525-3173
Mailing Address - Fax:
Practice Address - Street 1:167 LAS MITRAS LN
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-5682
Practice Address - Country:US
Practice Address - Phone:956-525-3173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-28
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4553103K00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst