Healthcare Provider Details

I. General information

NPI: 1205131901
Provider Name (Legal Business Name): ANGELA N LOPEZ LMT, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2011
Last Update Date: 02/26/2024
Certification Date: 02/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 E AND WEST RD
WEST SENECA NY
14224-3602
US

IV. Provider business mailing address

1010 E AND WEST RD
WEST SENECA NY
14224-3602
US

V. Phone/Fax

Practice location:
  • Phone: 716-677-7117
  • Fax:
Mailing address:
  • Phone: 716-830-1706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number021194
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number794053
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: