Provider Demographics
NPI:1174485254
Name:LOPEZ MATAMOROS, SAMANTHA
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:LOPEZ MATAMOROS
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 1:2280 1ST AVE LOT 39
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80631-7229
Mailing Address - Country:US
Mailing Address - Phone:970-515-9441
Mailing Address - Fax:
Practice Address - Street 1:2280 1ST AVE LOT 39
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-7229
Practice Address - Country:US
Practice Address - Phone:970-515-9441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-26
Last Update Date:2025-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter