Provider Demographics
NPI:1053747238
Name:LOPEZ, PATRICIA
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5203 JUAN TABO BLVD NE STE 2A
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-2691
Mailing Address - Country:US
Mailing Address - Phone:505-753-9719
Mailing Address - Fax:505-221-5710
Practice Address - Street 1:5203 JUAN TABO BLVD NE STE 2A
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-2691
Practice Address - Country:US
Practice Address - Phone:505-753-9719
Practice Address - Fax:505-221-5710
Is Sole Proprietor?:No
Enumeration Date:2013-09-19
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health