Active NPI
Jose Orlean Lopez de la Cruz III
- Surgical Assistant
- Austin, TX
National Provider Identifier
1700232345
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Assistant
- License
- 16-245
- Practice address
- 3603 Southridge Dr
Appartment 2031
Austin, TX 78704-7739 - Phone
- (786) 857-0656
- NPI assigned
- May 13, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Assistant | 246ZC0007X | 16-245 | TX | Primary |
Addresses
Primary practice location
3603 Southridge Dr
Appartment 2031
Austin, TX 78704-7739
Mailing address
3603 Southridge Dr
Appartment 2031
Austin, TX 78704-7739
Phone (786) 857-0656
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 711149917 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16-245 | TX | MD | Surgical Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1463097600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1463097600000",
"number": "1700232345",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3603 SOUTHRIDGE DR",
"address_2": "APPARTMENT 2031",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787047739",
"telephone_number": "786-857-0656"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3603 SOUTHRIDGE DR",
"address_2": "APPARTMENT 2031",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787047739",
"telephone_number": "786-857-0656"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LOPEZ DE LA CRUZ",
"first_name": "JOSE",
"middle_name": "ORLEAN",
"name_prefix": "Mr.",
"name_suffix": "III",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-05-13",
"last_updated": "2016-05-13",
"status": "A"
},
"taxonomies": [
{
"code": "246ZC0007X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Other, Surgical Assistant",
"state": "TX",
"license": "16-245",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "711149917",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Austin, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.