Individual
ANGELICA LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1087 E PARK BLVD, BOISE, ID 83712
(208) 504-1731
Mailing address
PO BOX 190311, BOISE, ID 83719-0311
(208) 596-3665
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
05/14/2021
Last updated
05/14/2021
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