| Lopez Sepulveda Primary Care Pllc | |
|
245 E Grauwyler Rd Suite 122 Irving TX 75061-2639 | |
| (972) 887-3235 | |
| (972) 887-3197 |
| Full Name | Lopez Sepulveda Primary Care Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 245 E Grauwyler Rd, Irving, Texas |
| Authorized Official Name and Position | Jaxel Lopez Sepulveda (PHYSICIAN/OWNER) |
| Authorized Official Contact | 9728873235 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lopez Sepulveda Primary Care Pllc 245 E Grauwyler Rd Ste 122 Irving TX 75061-2639 Ph: (972) 887-3235 | Lopez Sepulveda Primary Care Pllc 245 E Grauwyler Rd Suite 122 Irving TX 75061-2639 Ph: (972) 887-3235 |
| NPI Number | 1447795729 |
|---|---|
| Provider Enumeration Date | 12/22/2016 |
| Last Update Date | 11/14/2023 |
| Medicare PECOS PAC ID | 2264704659 |
|---|---|
| Medicare Enrollment ID | O20170819000004 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447795729 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | Q5020 (Texas) | Primary |
| Provider Name | Jaxel Lopez Sepulveda |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1598072563 PECOS PAC ID: 9638487705 Enrollment ID: I20151009001375 |
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