Healthcare Provider Details

I. General information

NPI: 1871727347
Provider Name (Legal Business Name): CLEA LYNN LOPEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2009
Last Update Date: 03/07/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 HOSPITAL DR STE 500
SANTA FE NM
87505-4794
US

IV. Provider business mailing address

1650 HOSPITAL DR STE 500
SANTA FE NM
87505-4794
US

V. Phone/Fax

Practice location:
  • Phone: 505-670-1976
  • Fax: 505-983-7212
Mailing address:
  • Phone: 505-670-1976
  • Fax: 505-983-7212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD2022-1054
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: