Provider Demographics
NPI:1134437775
Name:LOPEZ, SANDRA REYES (REGISTERED DIETICIAN)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:REYES
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:REGISTERED DIETICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 TREASURE HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-8911
Mailing Address - Country:US
Mailing Address - Phone:956-365-6750
Mailing Address - Fax:956-365-6779
Practice Address - Street 1:131 FM 3168
Practice Address - Street 2:
Practice Address - City:RAYMONDVILLE
Practice Address - State:TX
Practice Address - Zip Code:78580-3605
Practice Address - Country:US
Practice Address - Phone:956-689-2196
Practice Address - Fax:956-689-5937
Is Sole Proprietor?:No
Enumeration Date:2010-09-16
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
956241OtherLICENSE