Healthcare Provider Details

I. General information

NPI: 1427978287
Provider Name (Legal Business Name): ANGELICA LOPEZ LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 4TH ST NW STE E-2
LOS RANCHOS NM
87107-5800
US

IV. Provider business mailing address

PO BOX 292
ESPANOLA NM
87532-0292
US

V. Phone/Fax

Practice location:
  • Phone: 505-573-9230
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSWB-2026-0769
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: