Individual
SAMUEL ROGELIO LOPEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4106 N YVETTE DR, PHARR, TX 78577-7764
(956) 784-0292
Mailing address
4106 N YVETTE DR, PHARR, TX 78577-7764
(956) 784-0292
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/30/2019
Last updated
05/29/2021
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