Provider Demographics
NPI:1144077843
Name:LOPEZ, JUAN ROBERTO (RDN, LD)
Entity type:Individual
Prefix:MR
First Name:JUAN
Middle Name:ROBERTO
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 N K CTR APT T104
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-1550
Mailing Address - Country:US
Mailing Address - Phone:956-432-1578
Mailing Address - Fax:
Practice Address - Street 1:3301 N K CTR APT T104
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-1550
Practice Address - Country:US
Practice Address - Phone:956-432-1578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT84525133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered