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General NPI Number Information
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NPI Number | 1972388239
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Entity Type | Individual
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Provider Name | LESLIE LASHEA LOPEZ
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Gender | Male
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Dates
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Enumeration Date | 08/25/2023
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Last Update Date | 08/25/2023
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Provider Practice Location Address
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Address Line | 4210 MEADOWLARK LN SE
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City | RIO RANCHO
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State | NM
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Zip | 87124-1021
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Country | US
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Telephone | 505-560-9355
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Fax |
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Provider Business Mailing Address
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Address Line | 6008 TIERRA ST NE APT F
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City | ALBUQUERQUE
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State | NM
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Zip | 87111-7019
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Country | US
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Telephone | 760-658-3472
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | SWB-2023-0610
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License Number State | NM
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