Provider Demographics
NPI:1053661660
Name:LOPEZ, MARIVIC VINUYA (RNFA)
Entity type:Individual
Prefix:MRS
First Name:MARIVIC
Middle Name:VINUYA
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10701 BLUESTONE RD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76108-6930
Mailing Address - Country:US
Mailing Address - Phone:817-692-9666
Mailing Address - Fax:
Practice Address - Street 1:10701 BLUESTONE RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76108-6930
Practice Address - Country:US
Practice Address - Phone:817-692-9666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX715412163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant