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Individual

DILLON ETHAN LOPEZ

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
RSPS, MHPS

Contact information

Practice address
7400 BLANCO RD STE 126, SAN ANTONIO, TX 78216-4361
(210) 627-4017
Mailing address
7400 BLANCO RD STE 126, SAN ANTONIO, TX 78216-4361
(210) 627-4017

Taxonomy

Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
175T00000X
Peer Specialist
Primary
TX
246R00000X
Pathology Technician
246ZE0500X
EEG Specialist/Technologist

Other

Enumeration date
03/14/2023
Last updated
03/14/2023
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