Healthcare Provider Details

I. General information

NPI: 1659684041
Provider Name (Legal Business Name): RACHEL KAYLA DUTTON-LEYDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2010
Last Update Date: 07/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

541 QUANTUM RD NE
ALBUQUERQUE NM
87124-4502
US

IV. Provider business mailing address

521 SPRUCE ST SE APT 311
ALBUQUERQUE NM
87106-5236
US

V. Phone/Fax

Practice location:
  • Phone: 505-994-9178
  • Fax: 505-896-0478
Mailing address:
  • Phone: 505-501-5128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: