Provider Demographics
NPI:1689342875
Name:LOPEZ, KRISTY DEPREE
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:DEPREE
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:933 MADEIRA DR SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-3617
Mailing Address - Country:US
Mailing Address - Phone:505-804-9322
Mailing Address - Fax:
Practice Address - Street 1:600 PAISANO ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87123-1453
Practice Address - Country:US
Practice Address - Phone:505-266-0110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-01
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker