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General NPI Number Information
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NPI Number | 1336541184
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Entity Type | Individual
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Provider Name | THOMAS LOPEZ I
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Gender | Male
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Dates
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Enumeration Date | 09/24/2014
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Last Update Date | 09/24/2014
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Provider Practice Location Address
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Address Line | 4000 EDITH BLVD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87107-2222
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Country | US
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Telephone | 505-841-4259
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Fax | 505-841-4314
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Provider Business Mailing Address
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Address Line | PO BOX 33922
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City | SANTA FE
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State | NM
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Zip | 87594-3922
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Country | US
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Telephone | 505-310-0097
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 319419
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License Number State | NM
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