Individual
BENITO LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
4113 CROSSPOINT BLVD, EDINBURG, TX 78539-1803
(956) 603-1555
Mailing address
4113 CROSSPOINT BLVD, EDINBURG, TX 78539-1803
(956) 603-1555
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA11140
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA11140
TEXAS MEDICAL BOARD
TX
Enumeration date
03/24/2017
Last updated
03/16/2023
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