Healthcare Provider Details

I. General information

NPI: 1821214610
Provider Name (Legal Business Name): MARIA LYDIA AVENDANO SW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6910 NATALIE AVE NE CLEVELAND MS
ALBUQUERQUE NM
87110-1323
US

IV. Provider business mailing address

6910 NATALIE AVE NE CLEVELAND MS
ALBUQUERQUE NM
87110-1323
US

V. Phone/Fax

Practice location:
  • Phone: 505-881-9227
  • Fax:
Mailing address:
  • Phone: 505-881-9227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberI 3413
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: