Healthcare Provider Details

I. General information

NPI: 1376813071
Provider Name (Legal Business Name): DEMIAN HUEMAC RUBALCABA LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2012
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 UPTOWN BLVD NE STE 305
ALBUQUERQUE NM
87110-4148
US

IV. Provider business mailing address

2308 GANDERT AVE SE
ALBUQUERQUE NM
87106-9607
US

V. Phone/Fax

Practice location:
  • Phone: 505-219-1125
  • Fax:
Mailing address:
  • Phone: 505-610-3610
  • Fax: 505-248-1351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-09049
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: