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General NPI Number Information
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NPI Number | 1871727347
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Entity Type | Individual
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Provider Name | CLEA LYNN LOPEZ MD
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Gender | Female
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Dates
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Enumeration Date | 05/12/2009
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Last Update Date | 03/07/2025
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Provider Practice Location Address
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Address Line | 1650 HOSPITAL DR STE 500
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City | SANTA FE
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State | NM
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Zip | 87505-4794
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Country | US
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Telephone | 505-670-1976
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Fax | 505-983-7212
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Provider Business Mailing Address
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Address Line | 1650 HOSPITAL DR STE 500
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City | SANTA FE
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State | NM
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Zip | 87505-4794
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Country | US
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Telephone | 505-670-1976
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Fax | 505-983-7212
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD2022-1054
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License Number State | NM
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