Individual
MICQAUELLA RENEA LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
601 UNIVERSITY DR, SAN MARCOS, TX 78666-4684
(956) 651-2555
Mailing address
9501 N TAYLOR RD, MISSION, TX 78573-4606
(956) 651-2555
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
08/24/2023
Last updated
09/05/2024
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