Healthcare Provider Details

I. General information

NPI: 1336262690
Provider Name (Legal Business Name): CHRISTINA ELIZABETH VENTO PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINA VENTO FAY

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 08/03/2023
Certification Date: 08/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9301 INDIAN SCHOOL RD NE
ALBUQUERQUE NM
87112-2884
US

IV. Provider business mailing address

9652 SUN DANCER DR NW
ALBUQUERQUE NM
87114-6089
US

V. Phone/Fax

Practice location:
  • Phone: 505-218-6383
  • Fax: 505-636-6338
Mailing address:
  • Phone: 505-238-5897
  • Fax: 505-248-7779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0789
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number0016
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: