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6212 Casa Blanca Nw Albuquerque NM 87120-3190 | |
| (505) 363-7495 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 6212 Casa Blanca Nw, Albuquerque, New Mexico |
| Authorized Official Name and Position | Erica Denise Ortiz (OWNER/ADMINISTRATOR) |
| Authorized Official Contact | 5053637495 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
6212 Casa Blanca Nw Albuquerque NM 87120-3190 Ph: (505) 363-7495 | 6212 Casa Blanca Nw Albuquerque NM 87120-3190 Ph: (505) 363-7495 |
| NPI Number | 1396490462 |
|---|---|
| Provider Enumeration Date | 02/17/2022 |
| Last Update Date | 11/27/2023 |
| Certification Date | 11/27/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396490462 | NPI | - | NPPES |
| 87103567 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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