Healthcare Provider Details

I. General information

NPI: 1609851468
Provider Name (Legal Business Name): IRENE DIAZ MONJE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 MARBLE AVE NE
ALBUQUERQUE NM
87106-2058
US

IV. Provider business mailing address

1100 ARIAS AVE NW
ALBUQUERQUE NM
87104-2100
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-8506
  • Fax: 505-272-3466
Mailing address:
  • Phone: 505-242-7552
  • Fax: 505-272-3466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number70901
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: