Provider Demographics
NPI:1548650872
Name:LOPEZ, JOSE DANIEL (CSFA)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:DANIEL
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7919 ABBOTTS POINTE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-5478
Mailing Address - Country:US
Mailing Address - Phone:210-204-7728
Mailing Address - Fax:
Practice Address - Street 1:7919 ABBOTTS POINTE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78254
Practice Address - Country:US
Practice Address - Phone:210-204-7728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-26
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14-9444363AS0400X
TX149444363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX13507539OtherCAQH
149444OtherNBSTSA BOARD CERTIFICATION