Provider Demographics
NPI:1841316403
Name:LOPEZ, DEYANIRA (PA-C)
Entity type:Individual
Prefix:
First Name:DEYANIRA
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2821 MICHAEL ANGELO
Mailing Address - Street 2:SUITE 400
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-1404
Mailing Address - Country:US
Mailing Address - Phone:956-683-7900
Mailing Address - Fax:956-683-9910
Practice Address - Street 1:5326 E US HIGHWAY 83
Practice Address - Street 2:SUITE A-5
Practice Address - City:RIO GRANDE CITY
Practice Address - State:TX
Practice Address - Zip Code:78582-9409
Practice Address - Country:US
Practice Address - Phone:956-488-8820
Practice Address - Fax:956-488-8853
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03193363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA03193OtherSTATE LICENSE NUMBER