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Individual
NIDIA LOPEZ
Active
Individual
NIDIA LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA04792
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
204427301
—
TX
05
—
205265608
—
TX
01
—
809N07
BCBS
TX
01
—
830N22
BCBS
TX
01
—
P00889868
RAILROAD MEDICARE
TX
Enumeration date
04/26/2006
Last updated
12/12/2019
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