Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath |
NPI | 1811299431 |
---|---|
Provider Name | Alejandro Lopez |
First Address | Espanola, NM 87532-0971 |
Second Address | Espanola, NM 87532-2963 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2010 |
Last Update Date | 02/12/2010 |