Provider Demographics
NPI:1629179601
Name:LOPEZ, LEONORA JEANETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:LEONORA
Middle Name:JEANETTE
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:683 HARKLE RD STE B
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4750
Mailing Address - Country:US
Mailing Address - Phone:505-954-4422
Mailing Address - Fax:505-954-4433
Practice Address - Street 1:683 HARKLE RD STE B
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4750
Practice Address - Country:US
Practice Address - Phone:505-954-4422
Practice Address - Fax:505-954-4433
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM83244207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM32466Medicaid
NMD43223Medicare ID - Type Unspecified
NM32466Medicaid