Healthcare Provider Details

I. General information

NPI: 1063576817
Provider Name (Legal Business Name): JANET ELIZABETH HODDE-VARGAS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9426 INDIAN SCHOOL RD NE STE 2
ALBUQUERQUE NM
87112-2887
US

IV. Provider business mailing address

PO BOX 2341
CORRALES NM
87048-2341
US

V. Phone/Fax

Practice location:
  • Phone: 505-342-0400
  • Fax: 505-342-0500
Mailing address:
  • Phone: 505-342-0400
  • Fax: 505-342-0500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number632
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: