Organization
G MICHAEL LOPEZ, M.D.
Active
Parent organization
G MICHAEL LOPEZ, M.D.
Organization subpart
Yes
Provider details
NPI number
Legal business name
G MICHAEL LOPEZ, M.D.
Authorized official
DR. G MICHAEL LOPEZ M.D. (OWNER)
(505) 425-9311
Entity
Organization
Contact information
Practice address
105 MILLS AVE STE 300, LAS VEGAS, NM 87701-4169
(505) 425-9311
(505) 425-9047
Mailing address
105 MILLS AVE STE 300, LAS VEGAS, NM 87701-4169
(505) 425-9311
(505) 425-9047
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
CNP00739
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1568
BLUE CROSS BLUE SHIELD
NM
Enumeration date
11/21/2013
Last updated
11/21/2013
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