Healthcare Provider Details

I. General information

NPI: 1760629638
Provider Name (Legal Business Name): JULIA G. ZUNIGA LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2009
Last Update Date: 01/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2418 MILES RD SE
ALBUQUERQUE NM
87106-3224
US

IV. Provider business mailing address

11709 ROSEMONT AVE NE
ALBUQUERQUE NM
87112-5646
US

V. Phone/Fax

Practice location:
  • Phone: 505-246-9972
  • Fax:
Mailing address:
  • Phone: 505-440-1612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-0469
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: