Healthcare Provider Details

I. General information

NPI: 1871639385
Provider Name (Legal Business Name): LYDIA MONTES DE OCA LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 PARK AVE SW
ALBUQUERQUE NM
87102-2967
US

IV. Provider business mailing address

2910 DURANGO RD SW
RIO RANCHO NM
87124-0217
US

V. Phone/Fax

Practice location:
  • Phone: 505-764-2000
  • Fax: 505-764-2020
Mailing address:
  • Phone: 505-898-9649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberM06284
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: