Healthcare Provider Details

I. General information

NPI: 1952787368
Provider Name (Legal Business Name): MARTA GEORGINA VASQUEZ-MCNAMARA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARTA GEORGINA VASQUEZ

II. Dates (important events)

Enumeration Date: 08/07/2015
Last Update Date: 08/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 BROADWAY BLVD NE STE 500
ALBUQUERQUE NM
87102-2367
US

IV. Provider business mailing address

601 PEACEFUL MEADOWS DR NE
RIO RANCHO NM
87144-4073
US

V. Phone/Fax

Practice location:
  • Phone: 505-268-0701
  • Fax:
Mailing address:
  • Phone: 505-975-9853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: