Healthcare Provider Details

I. General information

NPI: 1740808187
Provider Name (Legal Business Name): MS. VICTORIA BEGAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2020
Last Update Date: 07/13/2020
Certification Date: 07/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 HAINES AVE NW
ALBUQUERQUE NM
87102-1226
US

IV. Provider business mailing address

KOA 555 S. HILL #27
BERNALILLO NM
87004
US

V. Phone/Fax

Practice location:
  • Phone: 505-268-5611
  • Fax:
Mailing address:
  • Phone: 928-797-8415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberT-CTL-0208481
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: