Healthcare Provider Details

I. General information

NPI: 1689502189
Provider Name (Legal Business Name): DIANDRA DAWN SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10800 COMANCHE RD NE APT 216
ALBUQUERQUE NM
87111-3967
US

IV. Provider business mailing address

10800 COMANCHE RD NE APT 216
ALBUQUERQUE NM
87111-3967
US

V. Phone/Fax

Practice location:
  • Phone: 505-238-0548
  • Fax: 833-542-9208
Mailing address:
  • Phone: 505-238-0548
  • Fax: 833-542-9208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: