Individual
GLADIS LOPEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3532 JON KIM LN, SANTA FE, NM 87507-9009
(505) 913-0493
Mailing address
3532 JON KIM LN, SANTA FE, NM 87507-9009
(505) 913-0493
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
06/15/2020
Last updated
06/15/2020
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