Provider Demographics
NPI:1346243847
Name:LOPEZ, HECTOR (DO)
Entity type:Individual
Prefix:
First Name:HECTOR
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11621 PELLICANO DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-6242
Mailing Address - Country:US
Mailing Address - Phone:915-504-8828
Mailing Address - Fax:915-206-5044
Practice Address - Street 1:11621 PELLICANO DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-6242
Practice Address - Country:US
Practice Address - Phone:915-206-5044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2025-02-20
Deactivation Date:2006-04-28
Deactivation Code:
Reactivation Date:2006-06-01
Provider Licenses
StateLicense IDTaxonomies
TXF9752207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX091877301Medicaid
TX091877301Medicaid
TX00SC66Medicare ID - Type Unspecified