Healthcare Provider Details

I. General information

NPI: 1124959929
Provider Name (Legal Business Name): HALEY LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5003 KOKOPELLI DR NE
RIO RANCHO NM
87144-0849
US

IV. Provider business mailing address

5003 KOKOPELLI DR NE
RIO RANCHO NM
87144-0849
US

V. Phone/Fax

Practice location:
  • Phone: 505-659-9602
  • Fax:
Mailing address:
  • Phone: 505-659-9602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: