Basic Information
| Provider Information | |||||||||
| NPI: | 1619113883 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EVA J LOPEZ MD PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | GC PHYSICIAN SERVICES | ||||||||
| Address2: | 2318 SAN PEDRO AVE STE 12 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782121901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102596338 | ||||||||
| FaxNumber: | 3862047372 | ||||||||
| Practice Location | |||||||||
| Address1: | 2318 SAN PEDRO AVE STE 12 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782121901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102596338 | ||||||||
| FaxNumber: | 3862047372 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/18/2008 | ||||||||
| LastUpdateDate: | 08/11/2022 | ||||||||
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| AuthorizedOfficialLastName: | LOPEZ | ||||||||
| AuthorizedOfficialFirstName: | EVA | ||||||||
| AuthorizedOfficialMiddleName: | JEANETTE | ||||||||
| AuthorizedOfficialTitleorPosition: | AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 2109129322 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 08/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | H4499 | TX | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.