Individual
MS. MICQAUELLA RENEA LOPEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, LAT, ATC
Contact information
Practice address
4301 BROADWAY, SAN ANTONIO, TX 78209-6318
(956) 651-2555
Mailing address
10018 INGRAM RD APT 6202, SAN ANTONIO, TX 78245-1966
(956) 651-2555
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
08/24/2023
Last updated
08/06/2026
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