Healthcare Provider Details

I. General information

NPI: 1487093340
Provider Name (Legal Business Name): TONYA NATALIE LOPEZ CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2013
Last Update Date: 06/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 HIGHWAY 60
SOCORRO NM
87801-3914
US

IV. Provider business mailing address

52 MOCKINGBIRD LN
SOCORRO NM
87801-5117
US

V. Phone/Fax

Practice location:
  • Phone: 505-610-1422
  • Fax:
Mailing address:
  • Phone: 505-610-1422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-02205
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: