Healthcare Provider Details

I. General information

NPI: 1083458285
Provider Name (Legal Business Name): MARIA R VILLAREAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2024
Last Update Date: 06/21/2024
Certification Date: 06/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3320 COORS BLVD NW STE C
ALBUQUERQUE NM
87120-1721
US

IV. Provider business mailing address

3301 COORS BLVD NW # R180
ALBUQUERQUE NM
87120-1292
US

V. Phone/Fax

Practice location:
  • Phone: 505-652-4002
  • Fax: 888-899-5534
Mailing address:
  • Phone: 505-652-4002
  • Fax: 888-899-5534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberM-09872
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: