Provider Demographics
NPI:1750516837
Name:LOPEZ, AMANDA L (AUD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:L
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7520 MONTGOMERY BLVD NE BLDG E15
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-1586
Mailing Address - Country:US
Mailing Address - Phone:055-872-4327
Mailing Address - Fax:505-872-1041
Practice Address - Street 1:7520 MONTGOMERY BLVD NE BLDG E15
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1586
Practice Address - Country:US
Practice Address - Phone:055-872-4327
Practice Address - Fax:505-872-1041
Is Sole Proprietor?:No
Enumeration Date:2009-05-19
Last Update Date:2020-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
237600000X
TX80350231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter