Healthcare Provider Details

I. General information

NPI: 1376297374
Provider Name (Legal Business Name): DANIEL GUARDADO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2022
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 RIO GRANDE BLVD NW STE G252
ALBUQUERQUE NM
87104-2050
US

IV. Provider business mailing address

4201 CARLISLE BLVD NE
ALBUQUERQUE NM
87107-4808
US

V. Phone/Fax

Practice location:
  • Phone: 505-702-8112
  • Fax: 505-355-2611
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2025-0873
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: