Individual
HENRY LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
105 BERTHA RD STE B, TAOS, NM 87571-7148
(575) 758-4297
Mailing address
1512 STATE RD 522, SAN CRISTOBAL, NM 87564
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
08/17/2022
Last updated
08/17/2022
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