Healthcare Provider Details

I. General information

NPI: 1699344150
Provider Name (Legal Business Name): LINDA LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2021
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 N ALAMEDA BLVD
LAS CRUCES NM
88005-2130
US

IV. Provider business mailing address

619 N ALAMEDA BLVD
LAS CRUCES NM
88005-2130
US

V. Phone/Fax

Practice location:
  • Phone: 575-405-7146
  • Fax: 575-405-5446
Mailing address:
  • Phone: 575-405-7146
  • Fax: 575-405-5446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberCTL0218091
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: