Provider Demographics
NPI:1093312480
Name:FIGUEROA LOPEZ, HERIBERTO (APRN)
Entity Type:Individual
Prefix:
First Name:HERIBERTO
Middle Name:
Last Name:FIGUEROA LOPEZ
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:HERIBERTO
Other - Middle Name:
Other - Last Name:FIGUEROA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:8100 WYOMING BLVD NE
Mailing Address - Street 2:SUITE M4 #308
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-2056
Mailing Address - Country:US
Mailing Address - Phone:505-633-4141
Mailing Address - Fax:505-633-4144
Practice Address - Street 1:4630 JEFFERSON LN NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-2117
Practice Address - Country:US
Practice Address - Phone:305-282-3784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-08
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11009389363L00000X, 363LG0600X
TX1113827363LG0600X
NM70185363LG0600X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology