Provider Demographics
NPI:1871726158
Name:LOPEZ, VERONICA HERNANDEZ (PA-C)
Entity type:Individual
Prefix:MS
First Name:VERONICA
Middle Name:HERNANDEZ
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:919 HIDDEN RDG
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-3813
Mailing Address - Country:US
Mailing Address - Phone:469-282-2711
Mailing Address - Fax:469-282-0996
Practice Address - Street 1:5802 SARATOGA BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-4252
Practice Address - Country:US
Practice Address - Phone:361-986-4600
Practice Address - Fax:361-985-0305
Is Sole Proprietor?:No
Enumeration Date:2009-09-02
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA0037363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1L5502OtherMEDICARE
TX284818605Medicaid
TX284818602Medicaid
TXP02601820OtherMCRR