Individual
AMANDA MAE LOPEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
336 AMBROSIA CT, RIO RICO, AZ 85648-2909
(520) 721-1887
(520) 407-5398
Mailing address
PO BOX 86537, TUCSON, AZ 85754-6537
(520) 721-1887
(520) 372-7126
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
8629369
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8629369
THERAPEUTIC FOSTER CARE
AZ
Enumeration date
05/01/2019
Last updated
01/29/2026
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