Provider Information for 1174860696
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Ms. OLUWASEYI ANNA LOPEZ PA-C, LPC
Sex: Female
NPI: 1174860696
Last Updated: 2024-03-04
Certification Date: 2024-03-04
Certification Date: 2024-03-04
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1174860696 | ||||||||||||
| Enumeration Date | 2013-01-04 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 11673 JOLLYVILLE RD STE 201 AUSTIN, TX 78759-4211 United States Phone: 512-579-0304 | Fax: | ||||||||||||
| Primary Practice Address | 11673 JOLLYVILLE RD STE 201 AUSTIN, TX 78759-4211 United States Phone: 512-579-0304 | Fax: | ||||||||||||
| Secondary Practice Address(es) | 9804 NIGHTJAR DR UNIT A | ||||||||||||
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