Healthcare Provider Details

I. General information

NPI: 1013112275
Provider Name (Legal Business Name): MS. FRANCESCA MARY CANGIALOSI II
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4903 4TH ST NW
ALBUQUERQUE NM
87107-3905
US

IV. Provider business mailing address

4724 SAM BRATTON AVE NW
ALBUQUERQUE NM
87114-5335
US

V. Phone/Fax

Practice location:
  • Phone: 505-342-5950
  • Fax: 505-342-5951
Mailing address:
  • Phone: 505-342-5950
  • Fax: 505-342-5951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberT-0100481
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: