Healthcare Provider Details

I. General information

NPI: 1467380618
Provider Name (Legal Business Name): MARY ISABELLA LOPEZ SWC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2026
Last Update Date: 05/09/2026
Certification Date: 05/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8270 W 80TH AVE UNIT 13
ARVADA CO
80005-5030
US

IV. Provider business mailing address

1500 N GRANT ST STE R
DENVER CO
80203-1859
US

V. Phone/Fax

Practice location:
  • Phone: 720-727-0404
  • Fax:
Mailing address:
  • Phone: 720-740-7013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSWC.0000002331
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: