Individual
MARK DOMINIC LOPEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
1501 SAN PEDRO DR SE, ALBUQUERQUE, NM 87108-5153
(505) 265-1711
Mailing address
5724 STRAND LOOP SE, ALBUQUERQUE, NM 87106-9606
(505) 681-5497
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
63927
NM
Other
Enumeration date
06/28/2021
Last updated
05/08/2022
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