Provider Demographics
NPI:1447838891
Name:LOPEZ, LIEZELLE CHUA (MD)
Entity type:Individual
Prefix:
First Name:LIEZELLE
Middle Name:CHUA
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 BATES AVE STE 1860
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2698
Mailing Address - Country:US
Mailing Address - Phone:832-824-5447
Mailing Address - Fax:832-825-0341
Practice Address - Street 1:1102 BATES AVE STE 1860
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2633
Practice Address - Country:US
Practice Address - Phone:832-824-5447
Practice Address - Fax:832-825-0341
Is Sole Proprietor?:No
Enumeration Date:2021-03-29
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH35.150558208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program