Individual
ISIDRO LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1273 S 2ND ST, RATON, NM 87740-2234
(575) 445-3557
Mailing address
PO BOX 94508, ALBUQUERQUE, NM 87199-4508
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
02/26/2014
Last updated
05/07/2020
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