Provider Demographics
NPI:1588087720
Name:LOPEZ, JOHN PAUL JR (CST,CSA)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:PAUL
Last Name:LOPEZ
Suffix:JR
Gender:M
Credentials:CST,CSA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3463 MAGIC DR
Mailing Address - Street 2:SUITE T21
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-2973
Mailing Address - Country:US
Mailing Address - Phone:210-614-8101
Mailing Address - Fax:210-614-8102
Practice Address - Street 1:3463 MAGIC DR
Practice Address - Street 2:SUITE T21
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-2973
Practice Address - Country:US
Practice Address - Phone:210-614-8101
Practice Address - Fax:210-614-8102
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-23
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX3957246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant