Basic Information
| Provider Information | |||||||||
| NPI: | 1104131770 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LOPEZ VAZQUEZ | ||||||||
| FirstName: | MANUEL | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3750 COMMERCIAL AVE | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782213117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2109227000 | ||||||||
| FaxNumber: | 2102717208 | ||||||||
| Practice Location | |||||||||
| Address1: | 5542 WALZEM RD | ||||||||
| Address2: | |||||||||
| City: | WINDCREST | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782182103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2109227000 | ||||||||
| FaxNumber: | 2105908970 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2010 | ||||||||
| LastUpdateDate: | 10/18/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Q7412 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.