Healthcare Provider Details

I. General information

NPI: 1689941551
Provider Name (Legal Business Name): VICTOR MANUEL ARREY MPA, LADAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2011
Last Update Date: 11/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 DOLORES DR NW
ALBUQUERQUE NM
87105-1954
US

IV. Provider business mailing address

1500 WALTER ST SE SUITE 108
ALBUQUERQUE NM
87102-4658
US

V. Phone/Fax

Practice location:
  • Phone: 505-715-9328
  • Fax: 505-242-1158
Mailing address:
  • Phone: 505-715-9328
  • Fax: 505-242-1158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number3841
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2364
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: