Provider Information for 1053735100
The following NPI(s) contain information matching your search criteria. Please select the NPI to view all the data associated with the NPI.
Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know
MANDY LOPEZ LCSW
Sex: Female
NPI: 1053735100
Last Updated: 2019-01-31
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1053735100 | ||||||||||||
| Enumeration Date | 2014-02-10 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 2710 BLUE MOON DR NE RIO RANCHO, NM 87144-4145 United States Phone: 505-901-0120 | Fax: | ||||||||||||
| Primary Practice Address | 6330 RIVERSIDE PLAZA LN NW STE 260 ALBUQUERQUE, NM 87120-2160 United States Phone: 505-226-2839 | Fax: | ||||||||||||
| Secondary Practice Address(es) | |||||||||||||
| Health Information Exchange |
| ||||||||||||
| Other Identifiers |
| ||||||||||||
| Taxonomy |
|