Healthcare Provider Details

I. General information

NPI: 1063139913
Provider Name (Legal Business Name): KIMBERLY LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2022
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 HILLRISE CIR
LAS CRUCES NM
88011-4759
US

IV. Provider business mailing address

305 COTTONWOOD ST
LAS CRUCES NM
88001-3004
US

V. Phone/Fax

Practice location:
  • Phone: 575-522-9500
  • Fax: 575-523-1108
Mailing address:
  • Phone: 575-522-9500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-88323
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: