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Individual

BRYAN BASULTO LOPEZ

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
CSA

Contact information

Practice address
18500 KATY FWY, HOUSTON, TX 77094-1110
(305) 335-0089
Mailing address
29310 PRAIRIE ROSE CT, KATY, TX 77494-7384
(305) 335-0089

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
24-361
WI

Other

Enumeration date
07/01/2025
Last updated
07/01/2025
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