Provider Demographics
NPI:1487744926
Name:LOPEZ, KEILA NATILDE (MD)
Entity type:Individual
Prefix:DR
First Name:KEILA
Middle Name:NATILDE
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1614 CALIFORNIA ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-2607
Mailing Address - Country:US
Mailing Address - Phone:847-334-0155
Mailing Address - Fax:
Practice Address - Street 1:6651 MAIN ST STE E1920
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2428
Practice Address - Country:US
Practice Address - Phone:832-826-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-115224208000000X
TXN52022080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB131363Medicare PIN