Provider Demographics
NPI:1376668442
Name:LOPEZ, ANGELA (LADC)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 E LAKE ST
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1547
Mailing Address - Country:US
Mailing Address - Phone:612-746-3500
Mailing Address - Fax:612-871-1058
Practice Address - Street 1:720 E LAKE ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-1547
Practice Address - Country:US
Practice Address - Phone:612-746-3500
Practice Address - Fax:612-871-1058
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNHP42372OtherH PARTNERS PROV NUMBER