Provider Demographics
NPI:1679500680
Name:LOPEZ, JULIET M (MD)
Entity Type:Individual
Prefix:
First Name:JULIET
Middle Name:M
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MD
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Other - Last Name:
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Mailing Address - Street 1:UNMHSC SPECIALTY EXTENSION SERVICES
Mailing Address - Street 2:MSC08-4600, 1 UNM
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87131-0001
Mailing Address - Country:US
Mailing Address - Phone:505-272-4861
Mailing Address - Fax:505-272-2360
Practice Address - Street 1:UNMHSC SPECIALTY EXTENSION SERVICES
Practice Address - Street 2:MSC08-4600, 1 UNM
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-0001
Practice Address - Country:US
Practice Address - Phone:505-272-4861
Practice Address - Fax:505-272-2360
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
NM2000-232208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
H43232Medicare UPIN