Healthcare Provider Details

I. General information

NPI: 1487060745
Provider Name (Legal Business Name): JEANETTA SALAZAR LADAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2014
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7709 REDBERRY ST NW
ALBUQUERQUE NM
87120-5235
US

IV. Provider business mailing address

7709 REDBERRY ST NW
ALBUQUERQUE NM
87120-5235
US

V. Phone/Fax

Practice location:
  • Phone: 575-418-8392
  • Fax:
Mailing address:
  • Phone: 575-418-8392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCAD0178381
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: