Individual
JOSE JULIAN LOPEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.S.A.A
Contact information
Practice address
COUNTY ROAD 41 PVT DRIVE 1098, VELARDE, NM 87582
(505) 852-2580
(505) 852-1827
Mailing address
P.O BOX 520, ESPANOLA, NM 87532
(505) 852-2580
(505) 852-1827
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
0064231
NM
Other
Enumeration date
09/28/2009
Last updated
09/28/2009
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