Healthcare Provider Details

I. General information

NPI: 1750516837
Provider Name (Legal Business Name): AMANDA L. LOPEZ AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2009
Last Update Date: 10/24/2020
Certification Date: 10/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7520 MONTGOMERY BLVD NE BLDG E15
ALBUQUERQUE NM
87109-1586
US

IV. Provider business mailing address

7520 MONTGOMERY BLVD NE BLDG E15
ALBUQUERQUE NM
87109-1586
US

V. Phone/Fax

Practice location:
  • Phone: 55-872-4327
  • Fax: 505-872-1041
Mailing address:
  • Phone: 55-872-4327
  • Fax: 505-872-1041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number80350
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: