Provider Demographics
NPI:1548787013
Name:LOPEZ, LILIANA ALEXIS (MS, CF-SLP)
Entity Type:Individual
Prefix:
First Name:LILIANA
Middle Name:ALEXIS
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2102 W AVENUE J
Mailing Address - Street 2:
Mailing Address - City:LOVINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:88260-3712
Mailing Address - Country:US
Mailing Address - Phone:575-689-5676
Mailing Address - Fax:
Practice Address - Street 1:18 W WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:LOVINGTON
Practice Address - State:NM
Practice Address - Zip Code:88260-4023
Practice Address - Country:US
Practice Address - Phone:575-739-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-25
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-6250235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMC-6250OtherSTATE LICENSE