Provider Demographics
NPI:1356603419
Name:LOPEZ, JESSICA AYALA
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:AYALA
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:ALWAYS
Other - Middle Name:FIRST
Other - Last Name:ASSISTING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:708 MEMORIAL MEWS ST APT A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-8408
Mailing Address - Country:US
Mailing Address - Phone:832-331-9438
Mailing Address - Fax:
Practice Address - Street 1:708 MEMORIAL MEWS ST APT A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-8408
Practice Address - Country:US
Practice Address - Phone:832-331-9438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical