Provider Demographics
NPI:1669211181
Name:LOPEZ, DANIELA P (PA)
Entity type:Individual
Prefix:
First Name:DANIELA
Middle Name:P
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1810 LINDBERG DR STE 2100
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-8160
Mailing Address - Country:US
Mailing Address - Phone:985-649-8461
Mailing Address - Fax:985-649-8488
Practice Address - Street 1:1810 LINDBERG DR STE 2100
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-8160
Practice Address - Country:US
Practice Address - Phone:985-649-8461
Practice Address - Fax:985-649-8488
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-23
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
363A00000X
LA343256363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant