Individual
MRS. LORI ANN MONDRAGON-LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1206 N RIVERSIDE DR, ESPANOLA, NM 87532-2811
(505) 747-7400
Mailing address
1206 N RIVERSIDE DR, ESPANOLA, NM 87532-2811
(505) 747-7400
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
104100000X
NM
Other
Enumeration date
11/06/2012
Last updated
02/22/2013
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