Healthcare Provider Details

I. General information

NPI: 1861160509
Provider Name (Legal Business Name): ADELIE RUAN PLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2021
Last Update Date: 04/12/2025
Certification Date: 04/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SOUTH VALLEY HEALTH CENTER 2001 CENTROL FAMILIAR SW
ALBUQUERQUE NM
87105
US

IV. Provider business mailing address

PO BOX 912678
DENVER CO
80291-2678
US

V. Phone/Fax

Practice location:
  • Phone: 505-877-4400
  • Fax:
Mailing address:
  • Phone: 505-241-5182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2025-0282
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberX-11841
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: