Healthcare Provider Details

I. General information

NPI: 1669040531
Provider Name (Legal Business Name): ANGELICA DELGADO LSAA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2021
Last Update Date: 07/07/2021
Certification Date: 07/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 HAINES AVE NW
ALBUQUERQUE NM
87102-1226
US

IV. Provider business mailing address

630 HAINES AVE NW
ALBUQUERQUE NM
87102-1226
US

V. Phone/Fax

Practice location:
  • Phone: 505-268-5611
  • Fax:
Mailing address:
  • Phone: 505-268-5611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCSA0215401
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: