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NPI Code Detail

MEDICARE: ANGELICA F WHITAKER

MEDICARE: ANGELICA F WHITAKER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) CounselorCTB-2025-0602NM

General Provider Information

NPI Number : 1407734734
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGELICA F WHITAKER
Provider Business Mailing Address
First Line : 1009 RIDGEWAY PL
Second Line :
City : FARMINGTON
State : NM
Zip : 87401-2092
Country : US
Telephone Number : 970-589-0797
Fax Number :
Provider Business Practice Location Address
First Line : 1009 RIDGEWAY PL
Second Line :
City : FARMINGTON
State : NM
Zip : 87401-2092
Country : US
Telephone Number : 505-402-6886
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/25/2025
Last Update Date : 06/02/2026

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Directions to “ ANGELICA F WHITAKER ” Practice Location

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