Provider Demographics
NPI:1295136984
Name:LOPEZ, ESTELA GUZMAN
Entity type:Individual
Prefix:MRS
First Name:ESTELA
Middle Name:GUZMAN
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 1:1101 LOPEZ RD SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUEQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87105
Mailing Address - Country:US
Mailing Address - Phone:505-877-7060
Mailing Address - Fax:505-877-7063
Practice Address - Street 1:1101 LOPEZ RD SW
Practice Address - Street 2:
Practice Address - City:ALBUQUEQUE
Practice Address - State:NM
Practice Address - Zip Code:87105
Practice Address - Country:US
Practice Address - Phone:505-877-7060
Practice Address - Fax:505-877-7063
Is Sole Proprietor?:No
Enumeration Date:2014-09-12
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator