Doctor Name: | LEA LOPEZ-FAGIN |
NPI Number: | 1306953385 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP |
License Number: | 428422 |
Business Practice Address: | 13409 Nw Military Hwy Suite 302 Shavano Park, TX - 782311800 |
Business Phone Number: | 2104793297 |
Business Fax Number: | 2104793295 |
Mailing Address: | 13409 Nw Military Hwy, Suite 302 SHAVANO PARK |
State: | TX |
Postal Code: | 782311800 |
Phone Number: | 2104793297 |
Fax Number: | 2104793295 |
NPI Enumeration Date: | 08/24/2006 |
NPI Last Update Date: | 06/04/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 428422 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |