Healthcare Provider Details

I. General information

NPI: 1912630005
Provider Name (Legal Business Name): ANDRES GILBERTO AVILES RAMOS MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2022
Last Update Date: 07/06/2022
Certification Date: 07/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 VENICE AVE NE STE A
ALBUQUERQUE NM
87113-2337
US

IV. Provider business mailing address

2316 ALGODONES ST NE
ALBUQUERQUE NM
87112-3406
US

V. Phone/Fax

Practice location:
  • Phone: 505-916-2007
  • Fax:
Mailing address:
  • Phone: 804-210-0756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2022-0280
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: